Perioperative Observation Essay Example

patients varies little from that of patient scheduled for a laparotomy and the same points should be considered. The patient is positioned in a supine position but may be tilted into a reverse Tredelenburg position intraoperatively.Other aspects for consideration during these procedures are the following: laparoscopic procedure may convert to a laparotomy at any time and the appropriate instrumentation should be available; patient must be made aware of this possibility; laparoscopic instrumentation an equipment should be assembled and be in good working order before commencement; insufflations pressure must be set to 15 mmHg as exceeding this may lead to changes in blood pressure, bradychardia or the development of gas emboli in an exposed blood vessel; pressure flow of the CO2 gas should not exceed 21 min. suction and electrosurgical equipment should be in good working order; a method for defogging the laparoscope should be available, e. g. , warm water.

Laparoscopic procedures have the benefit of shorter hospitalization, earlier ambulation, decreased post operative pain, lower wound-related morbidity, and more rapid return to normal activities. Perioperative Care: Trauma Any clotting defect which may be present is rectified and, once the patient’s condition has stabilized, she is prepared for surgery. Close observation of the patient is required throughout this period.If at all possible, it is helpful to allow close relatives to see the patient before surgery as this may relieve a little of both their patient’s anxiety. Post operative care is as for abdominal surgery requiring general anesthesia and the patient will usually be nursed in a high-dependency area.

Perioperative Care: Hypersplenism In preparation for elective splenectomy, a full assessment of the patient’s blood count and coagulation status must

be made. In the presence of any bleeding tendency, a transfusion of blood or platelets may be administered.In patients with thrombocytopenia, platelets should be made available for use to cover the intra- and post operative phase. An anti-pneumococcal vaccine is given to prevent or minimize chest infection postoperatively.

Influenza Type B vaccine is also given prophylactically. Preparation for surgery is as for abdominal surgery requiring general anesthesia. A nasogastric tube is passed because of handling of the stomach during surgery and the subsequent risk of aspiration of stomach contents.In the postoperative period, the physiotherapist plays an important role in the care of these patients because of the increased risk of collapse of the left lower lobe of the lung.

The nurse must encourage the patient to perform deep breathing exercises and aid expectoration between physiotherapy sessions. Some doctors advise the administration of low-dose heparin in all patients undergoing splenectomy as there will be a transient increase in platelet and leukocyte levels.The nurse must therefore be aware of the importance of passive exercises while the patient is on bed rest and encourage movement and early ambulation. Another complication which can follow splenectomy is pancreatitis caused by the handling and bruising of the tail of the pancreas during surgery. Therefore the nurse must be alert to any change in the patient’s condition, especially any increase or change in the nature of the pain experienced.