Surgical Management

Collorectal

Laparotomy
A laparotomy is a large incision made into the abdomen

Colostomy
Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.

Segmental resecton withanastomosis

Removal of the tumor and portions of the bowel on either side of the growth, as well as the blood vessels and lymphatic nodes.

Nursing diagnosis
Fear related to operation procedure. Disturb body image related to coloston. Ineffective sexuality patterns related to presence of colostomy and changes in body image and self-concept.

Nursing responsibilities: Before

1) Instruct patient to be in NPO for 8hrs before surgery. 2) Instruct the patient to avoid dark color foods for 3 to 4 days before operation.

3) Instruct the patient to be in low residue diet prior to operation.

4) Show them a diagram of the intestine before surgery, stressing how much of the bowel will remain intact

 5) Discuss the importance of deep breathing exercises and coughing exercise. 6) Administer laxatives, enemas, and antibiotic (Neomizine) 7) Ensure that the patient signed a consent.

Nursing responsibilities: After

1) Monitor client vital signs 2) Monitor patient closely for complications 3) Advise the patient that she/he my resume normal activities after 2 days. 4) Monitor patient for abdominal pain.

 5) Encourage the patient to look at the stoma and participate at its care as soon as possible. 6) Asses type and sensitivity of pain and administer analgesics as needed for pain. 7) Teach good hygiene and skin care.

Prognosis
1) Early diagnosis and prompt treatment could save almost three of every year four people with colorectal cancer. 2) Improve screening strategies have helped to reduce number of deaths. 3) If the disease is detected and treated at an early stage, the 5-year survival rate is 90% but only 34% of colorectal cancers are found at an early stage.

Surgical Management

Liver

Liver resection
Removes the part of the liver that contains the cancer.

hepatectomy
Excision of the liver or of part of the liver.

Nursing diagnosis
1) Risk for Infection related to invasive procedures (tools during surgery). 2) Pain related to operation 3) Acute pain related to surgical procedure.

Nursing responsibilities: Before

1) Ensure that the patient signed a consent. 2) Prepare the patient for surgery. 3) Instruct the patient to undergo NPO

After:
1) Give analgesics as ordered and encourage the patient to identify care measures that promote comfort. 2) Provide patient with a special diet that restricts sodium, fluids, and protein and that prohibits alcohol. 3) Monitor client vital signs.

Prognosis
1) A repeat hepatectomy for recurrent hepatocellular carcinoma has been established as the most effective treatment modality, whenever it is possible. However, the prognostic factors for recurrent HCC after repeat hepatectomy have yet to be clarified. 2) The deterioration of disease-free or overall survival of patients with hepatocellular carcinoma after hepatectomy correlates with increasing number of risk factors. 3) The frequency of tumor recurrence depends on the time of follow-up. In different series between 43% and 65% of the patients had recurrences within 2 years of removal of the first tumor, and up to 85% within 5 years.

Surgical Management Brain

Craniotomy
Surgical operation in which a bone flap is temporarily removed from the skull to access the brain.

Nursing diagnosis
1) Impaired physical mobility related to immobilization after a surgery. 2) Pain related to surgical incision. 3) Anxiety related to uncertain future and prognosis

Nursing responsibilities: Before

1) Ensure that the patient signed a consent. 2) Administration of medication to ease anxiety and to decrease the risk of seizures, swelling, and infection after surgery. 3) Shave the patient`s head

Nursing responsibilities: After

A. Head dressing 1. Generally a snug turban-style dressing 2. Important to monitor the dressing for drainagenurse should outline drainage directly on dressing and continue to monitor for increase in drainage beyond outline. 3. Precise removal time is institution specific. 4. In general, head dressings are removed after 24 hours. 5. After removal, a smaller dressing may be applied or the incision can be left open to air.

Drains 1. Be certain you know the location of each drain and label them clearly. 2. Never place a drain to wall suction. 3. Subgaleal drains can be placed to full bulb suction. 4. Drains in the subdural space are either drained to gravity or to partial bulb suction. 5. Aggressive suction on the brain surface can tear vessels and cause hemorrhage.

 Incision care 1. Monitor the incision for redness or drainage or signs of wound infection. 2. Keep the incision with staples or stitches dry. C. Jackson Pratt (JP) drain 1. Occasionally placed in the surgical bed 2. Requires monitoring and measurement of the drainage 3. Maintain patency of the drain 4. Not placed in the surgical bed if the physician has placed biodegradable wafers, which release chemotherapy

Prognosis
1 ) Recovery from craniotomy itself can be fairly rapid after a successful, uncomplicated surgery. The recovery period generally varies from 1 to 4 weeks, with full recovery lasting up to 8 weeks. 2) Predicted outcome after a craniectomy depends upon the underlying condition, the success of the surgical procedure performed through this approach, and the number and severity of postoperative complications.

3) Individuals who suffer permanent brain damage from bleeding, infection, or increased intracranial pressure may have decreased cognitive ability. They may not be able to perform tasks they could before surgery. In some cases, the impairment can be severe enough to require permanent disability.

Surgical Management

Surgical Management

Prostate

Prostatectomy
Prostatectomy refers to the surgical removal of part of the prostate gland (transurethral resection, a procedure performed to relieve urinary symptoms caused by benign enlargement), or all of the prostate (radical prostatectomy, the curative surgery most often used to treat prostate cancer).

Nursing diagnosis
1) Risk for Infection related to invasive procedures (tools during surgery). 2) Impaired urinary elimination related to surgical procedure. 3) Risk for sexual dysfunction

Nursing responsibilities: Before

1) Bowel preparation with a 2% neomycin enema may be ordered. This cleanses the bowel if a perineal approach will be used.

2) Asses the man`s family`s knowledge about surgery.

3) Inform the man that he will have a urinary catheter when he returns from surgery, and he may have a drain(s) in his incision.

Nursing responsibilities: After

1) Assess and manage the mans pain. The man may have at least three types of pain: incisional pain, bladder spasm, and abdominal cramps due to intestinal gas. 2) Encourage the man to maintain a liberal fluid intake of 2 to 3L a day. 3) Assist with leg exercises and ambulation as ordered, usually the first postoperative day.

1)Several randomized studies have been completed in prostate cancer that show a benefit to immediate postoperative treatment in patients undergoing prostatectomy. In one of the studies, there was even a survival advantage. In spite of those positive findings, there has been some reluctance to uniformly offer adjuvant treatment to patients.

Prognosis
2) Prostate cancer is one of the most common cancers in Western countries and is associated with a considerable risk of mortality. Biochemical recurrence following radical prostatectomy is a relatively common finding, affecting approximately 25% of cases.

3) In Canada, it is estimated that 1 in 7 men will develop prostate cancer during their lifetime, and 1 of 27 will die of it (a ratio of 1 death per 4 diagnosed cases)

Surgical Management
Thyroidectomy

Thyroidectomy
Surgical procedure in which all or part of the thyroid gland is removed. The thyroid gland is located in the forward part of the neck (anterior) just under the skin and in front of the Adam's apple.

Nursing diagnosis
1) Impaired verbal communication related to pain 2) Risk for ineffective airway clearance 3) Risk for head/neck trauma

Nursing responsibilities: Before

1) Administer ordered anti thyroid medications and iodine preparations, and monitor their effects. Anti thyroid drugs are given before surgery to promote a thyroid state. Iodine preparations are given to the client before surgery to decrease vascularity of the gland, thereby decreasing the risk of hemorrhage. 2) Teach the client to support the neck by placing both hands behind the neck when sitting up in bed, while moving about, and while coughing. Placing the hands behind the neck provides support for the suture line.

 3) Answer questions, and allow time for the client to verbalize concerns. Because the incision is made at the base of the throat, clients (especially women) are often concerned about their appearance after surgery. Explain that the scar will eventually be only a thin line and that jewelry or scarves may be used to cover the scar.

Nursing responsibilities: After

1) Provide comfort measures: Administer analgesic pain medications as ordered, 2) Monitor patient closely for complications. 3) monitor their effectiveness; place the client in a semi-Fowlers position after recovery from anesthesia; support head and neck with pillows

Prognosis
1) Following partial thyroidectomy, thyroid function returns to normal in 90% to 98% of cases, although up to 50% of individuals may experience hypothyroidism during the first year after surgery. 2) Thyroidectomy is excellent, with a mortality rate of almost 0%. 3) The individuals undergoing a total thyroidectomy, and some of those undergoing a partial thyroidectomy, will require lifelong treatment with thyroid hormone replacement.