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Questions and Answers
What is the primary reason for assessing a patient's pain tolerance in the postoperative setting?
What should be confirmed pre-, intra-, and post-operatively regarding blood products?
Which position is typically associated with gastrointestinal surgeries?
What is the purpose of the initial major count in surgical procedures?
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What type of blanket is used during surgeries to prevent hypothermia?
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What is the primary purpose of gastrointestinal surgery?
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Which instruments are specifically used for clamping the stomach during surgery?
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Which artery supplies the large intestine from the left colic flexure to the upper part of the rectum?
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Why is the continuous assessment of a patient's temperature necessary during surgery?
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What is an important consideration in the nursing assessment for gastrointestinal surgery?
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What is the recommended collaboration role of the perioperative nurse during surgery?
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Which of the following best describes a key aspect of bowel technique in gastrointestinal surgery?
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Which surgical technique involves the use of various staplers for the GI tract?
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What is the main challenge during a laparoscopic Nissen full fundal wrap procedure?
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What is meant by 'perioperative nursing considerations' in the context of GI surgery?
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What are the implications of unexpected outcomes during gastrointestinal surgery?
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What is the most popular method for gastrostomy tube placement?
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Which of the following is NOT a reason for performing gastrointestinal surgery?
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What procedure is indicated for increasing the diameter of the pyloric sphincter?
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What type of gastrectomy removes the entire stomach?
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What is the main purpose of bariatric surgery?
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What does Roux-en-Y gastric bypass achieve in a bariatric surgery context?
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Which type of gastrectomy specifically involves connecting the stomach to the duodenum?
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In a laparoscopic Nissen fundoplication, what can happen if the wrap around the esophagus is too loose?
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What is the main purpose of mesenteric repair during bowel removal?
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What type of suture is typically used for repairing the internal serosa?
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What is the role of the dilator in the open Nissen fundoplication procedure?
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What is the main concern with the blood supply during mesenteric defect repair?
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Which surgical technique is specifically developed for managing GERD?
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What is the characteristic feature of the Nissen Fundoplication procedure?
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Which sutures are commonly used for external serosa repair?
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What condition does GERD primarily result from?
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What is the primary reason for creating a temporary colostomy or ileostomy?
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What does the Hartmann Colostomy involve?
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In which situation is an Abdominoperineal Resection typically required?
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What is created during the Ileal Anal Pull Through procedure?
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What characterizes a permanent colostomy after bowel resection?
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What happens during the closure of a Hartmann Colostomy?
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Which procedure eliminates the need for an ileostomy in patients with ulcerative colitis?
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What is a primary function of a temporary colostomy in emergency scenarios?
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Study Notes
Gastrointestinal Surgery Overview
- Gastrointestinal (GI) surgery addresses conditions of the esophagus, stomach, small intestine, large intestine, and rectum for diagnosis, disease prevention, symptom relief, restoration of function, and palliative care.
- Subspecialty under general surgery aimed at surgical management of GI conditions.
Anatomy and Blood Supply
- Superior mesenteric artery: Supplies intestines from duodenum and pancreas to left colic flexure.
- Inferior mesenteric artery: Supplies large intestine from left colic flexure to upper rectum.
Perioperative Nursing Considerations
- Risk assessments should be performed to anticipate potential complications and unexpected outcomes.
- Preoperative skin assessments identify high-risk areas for pressure injuries.
- Bariatric patients require special attention due to comorbidities influencing surgery risk.
- Blood product availability must be confirmed pre-, intra-, and post-operatively, especially during extensive tissue dissection.
Patient Positioning
- Typically, patients are positioned supine or in modified lithotomy depending on the procedure.
- Positioning aids like bean bags and bolsters may be utilized, and safety protocols must be strictly followed.
Instrumentation and Counting
- Use of basic laparotomy instrument sets and specialized instruments as per surgical preference.
- Major counts (initial and closing) ensure no instruments or sponges are retained in the body.
Equipment and Monitoring
- Forced-air warming blankets are crucial for preventing hypothermia due to extensive skin exposure during surgery.
- Continuous temperature monitoring is necessary to maintain normothermia.
Surgical Techniques and Procedures
- GIA Stapler: Used for creating side-to-side anastomosis during bowel resection.
- Mesenteric defect repair: Required when bowel is removed to prevent postoperative complications.
Types of Surgeries
- Nissen Fundoplication: Addresses GERD by wrapping the upper stomach around the lower esophagus; can be performed open or laparoscopically.
- Gastrostomy (PEG): Flexible gastroscope used for tube placement under moderate sedation.
- Gastrectomy: Involves total or partial removal of the stomach; can lead to Roux-en-Y anastomosis.
Bariatric Surgery
- Aims to assist in weight loss; typically performed laparoscopically.
- Roux-en-Y gastric bypass is a common technique reducing stomach size and altering nutrient absorption.
Colostomy and Ileostomy Creations
- Temporary Colostomy: Allows healing or rest of the bowel.
- Permanent Colostomy: Created in emergency situations or cancer cases leading to bowel resection.
- Hartmann Procedure: Emergency colostomy due to perforation risks, involving subsequent closure depending on patient recovery.
- Ileal Anal Pull Through: Applicable for ulcerative colitis, where the large bowel and part of the rectum are removed, creating a pouch from the small intestine.
Closure Techniques
- Manual suturing may be required post-stapling; absorbable sutures for internal serosa and permanent for external serosa.
Key Takeaways
- GI surgery involves complex procedures that require thorough preparation, awareness of anatomical structures, and careful management of patient positioning and monitoring.
- Understanding surgical techniques and post-operative care is essential for effective patient outcomes.
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Description
Test your knowledge on gastrointestinal surgery with this quiz based on Module 14 of Alexander’s Care of the Patient in Surgery and ORNAC Standards 2023. Assess your understanding of anatomy, procedural considerations, and different surgical staplers. Ideal for medical students and surgical practitioners.