Surgical Nursing: Procedures, Diagnosis & Treatment

SURGICAL NURSING 11 KNUR 216 SURGICAL NURSING APPLY TO :  PRE – OPERATIVE CARE.  INTRA – OPERATIVE CARE  POST –OPERATIVE CARE.  ALL SURGICAL CONDITION  PRE – OPERATIVE CARE  Preparing the patient for surgery – physical, spiritual, psychological and physiolog...

SURGICAL NURSING 11 KNUR 216 SURGICAL NURSING APPLY TO :  PRE – OPERATIVE CARE.  INTRA – OPERATIVE CARE  POST –OPERATIVE CARE.  ALL SURGICAL CONDITION  PRE – OPERATIVE CARE  Preparing the patient for surgery – physical, spiritual, psychological and physiological.  Reviewing consent form.  Performing assessment.  Answering questions  INTRA – OPERATIVE CARE  Maintaining a sterile environment during the surgery.  Handing tools the surgeon properly.  Ensuring all tools are ready.  Ensuring all tools used on the patient are tallied before closing up.  Proper documentation of the outcome of surgery.  POST – OPERATIVE CARE  Focuses on immediate hemodynamics stabilization and recovery.  Proper and adequate pain management.  Strict intake and output of fluids  Effective and early wound healing.  OESOPHAGEAL STRICTURE ACHALASIA  THE ESOPHAGUS IS THE PART OF THE GIT THAT LINKS THE MOUTH AND THE STOMACH.  THIS IS A CONDITION OF THE LOWER PART OF THE ESOPHAGUS WHERE THERE IS NARROWING MAKING IT DIFFICULT FOR FOOD OR LIQUID TO PASS TO THE STOMACH.  IT IS A RARE SWALLOWING DISORDER  TYPES - ACHALASIA Type 1 : Classic achalasia.  Type2 : Pressure builds up in the esophagus causing it to become compressed.  Type 3 : this type is called spastic achalasia, because there is abnormal / premature contraction at the bottom of the esophagus where it meets the stomach.  CAUSES - ACHALASIA  The exact cause is not known, but there possible causes; these are ;  Viral infections.  Autoimmune disorders (inflammatory).  Genetic disorders ( faulty).  Weakened immune system.  RISK FACTORS - ACHALASIA  Age :25 – 60 years.  Certain medical conditions ; people with allergic disorders, adrenal insufficiency.  SIGNS AND SYMPTOMS  Difficulty in swallowing.  Painful in swallowing.  Frequent regurgitation of undigested food and saliva.  Bad breath.  Chest pain.  Back pain.  Shoulder pain  SIGNS AND SYMPTOMS CONTD  In severe / worse situation, the patient prefer to sleep in a sitting up position.  Symptoms worsen with stress or indigestion of cold liquids.  Weight loss  DIAGNOSIS – ACHALASIA.  Esophageal manometry – gold standard. – measures the motion and the contractility.  X – ray of the upper GIT.  Upper endoscopy. – esophagogastroduodenoscopy.  Functional luminal imaging probe  SURGICAL TREATMENT – ACHALASIA.  Heller myotomy - Dilation of the esophageal stricture.  SURGICAL PREPERATION – Pre –op , intra – op and post –op.  COMPLICATIONS - ACHALASIA  Bleeding. Fortunately, bleeding during or after this procedure is very uncommon....  Infection. Infection from esophageal myotomy can occur in the incision, in another organ such as the lungs or at the site of the myotomy..  Recurrent of the stricture  CORONARY ARTERY DISEASE (CAD )  This is a type of the chronic heart disease.  It is a condition of the heart, where the blood supply (arteries ) to the heart is diminished over time.  Gradual reduction of blood supply is due to the deposition and building of plaque ( atheroma - cholesterol ) in the walls of the arteries.  This condition develops over years.  SIGNS AND SYMPTOMS  Chest pain - Angina, : the pain is felt around the middle or the left chest. Activity or strong emotion can trigger the pain.  Pain in the neck, jaw, throat, upper belly or back.  Pain, numbness, weakness or coldness in the legs or arms  Shortness of breath - a feeling of difficulty in breathing.  Fatigue - feeling of unusually tired.  Cold sweats.  Heartburn.  Lightheadedness or sudden dizziness.  Shortness of breath.  RISK FACTORS  These factors can be grouped into two (2) :  Those can not be controlled.  Age - getting older increases the risk of damaged and narrowed arteries.  Birth sex –men are at risk of the condition but women become higher after menopause..  Family history  RISK FACTORS CONTD  Risk factors that can be controlled :  Smoking.  High blood pressure.  Cholesterol - too much bad (low density lipoprotein)  Diabetes.  Obesity.  Chronic kidney disease.  Not getting enough exercise.  A lot of stress.  Unhealthy diet.  Alcohol intake.  Amount of sleep.  DIAGNOSIS  Clinical assessment.  Diagnostic investigations –  Electrocardiogram.  Stress test.  Echocardiogram.  Cardiac catheterization.  Computed tomography (CT) coronary angiogram.  Heart MRI (magnetic resonance imaging ).  Coronary calcium scan.  Chest X-Ray.  TREATMENT - SURGERY  The following are the surgical procedures that can be performed :  Coronary Angioplasty (Percutaneous coronary intervention PCI ) – the narrowed artery is stretched opened with a balloon.  Stent replacement -a metal strut (stent )is implanted  Coronary artery bypass graft ( CABG ) or Off – pump coronary artery bypass - A healthy blood vessel(vein from leg, chest, arm or belly ) is used to reroute blood around the blocked artery.  SURGICAL TREATMENT – CAD. CONTD  Trans myocardial laser revascularization.  Coronary endarterectomy.  Heart transplant.  Valve surgery  INTERSTINAL OBSTRUCTION  Definition - Is a partial or complete blockage pf the bowel that results in the failure of the intestinal contents to pass through.  Is a potentially serious condition of either the small or the large bowel.(intestines ).  When the bock occurs, food and sometimes liquids cannot pass through.  The obstruction is serious and needs to be treated immediately and may even require surgery. TYPES OF INTESTINAL OBSTRUCTION  Mechanical obstruction - usually caused by an occlusion of the lumen of the intestinal tract from pressure on the intestinal walls. Eg are intussusceptions, polypoid hernias and abscess.  Functional obstruction - The intestinal musculature fails to propel the content along the bowel. Eg amyloidosis, muscular dystrophy, endocrine disorders as in DM or neurologic disorders as in Parkinson's disease.  ETIOLOGY / RISK FACTORS OF INTESTINAL OBSTRUCTION  Abdominal or pelvic surgeries complications eg adhesions.  Crohn’s disease.  Cancer within the abdomen.  Paralytic ileus (pseudo obstruction ).  Volvulus - twisting of the intestines.  Intussusception -Telescoping of the intestines.  Diverticulitis -- infection of the diverticulum.  Impacted feces.  Narrow of the colon.  Accidents. CLINICAL MANIFESTATION OF INTESTINAL OBSTRUCTION  Abdominal fullness ( feeling of gas in the abdomen) or distention.  Abdominal pain and cramping.  Breath odor.  Constipation.  Diarrhea.  Vomiting.  Fever.  Failure to pass stools.  Absence of flatus.  Fatigue  DIAGNOSIS OF INTESTINAL OBSTRUCTION  A thorough history taking and physical assessment.  Abdominal X – ray or CT scans.  Full / complete blood count and blood urea, nitrogen and electrolytes ( amylase ).  Barium enema - an x- ray of the intestines after ingestion of a liquid (barium sulphate ) to highlight the colon and retum.  Sigmoidoscopy, / Colonoscopy - scope inserted to view the sigmoid/ colon respectively.  SURGICAL INTERVENTION OF INTESTINAL OBSTRUCTION  Laparotomy to explore the abdominal content.  Resection and anastomosis of the areas of constricting bands or adhesions.  Temporal colostomy performed till patient is better , the resection and anastomosis is done. COMPLICATIONS OF INTESTINAL OBSTRUCTION.  Dehydration.  Shock.  Electrolytes imbalance.  Infection.  Jaundice.  Perforation in the intestines.  Peritonitis.  Sepsis.