Jumat, 31 Agustus 2012

NURSING CARE PATIEN laparotomy


Definition
Abdominal surgery to open up the stomach lining.
There are four ways, namely;
1. Midline incision
2.  paramedian, ie, slightly to the side of the center line (
±2.5 cm), length (12.5 cm).
3. Transverse upper abdominal incision, namely an incision at the top, such as surgery and splenektomy colesistotomy.
4. Transverse  4 cm lower abdominal incision, namely; incision across the bottom on
± the anterior iliac spine, eg appendictomy operations.

Indication
1. Abdominal trauma (blunt or sharp)
2. Peritonitis
3. GI bleeding.
4. Blockage of the small intestine and colon.
5. The period of the abdomen


Complication
1. Inadequate pulmonary ventilation
2. Cardiovascular Disorders: hypertension, cardiac arrhythmias.
3. Disorders of fluid and electrolyte balance.
4. Impaired sense of comfort and accidents

Physical exercises
Practice deep breathing, coughing exercises, move your leg muscles, move your butt muscles, exercise lying over and got out of bed. Everything is done postoperative day 2.



POST laparotomy
Laparotomy post treatment is a form of care given to patients who have undergone abdominal surgery.

Treatment goal post laparotomy;
1. Reducing complications from surgery.
2. Accelerate healing.
3. Restoring the function of patients as much as possible before surgery.
4. Maintaining the patient's self concept.
5. Preparing the patient goes home.

Complications of post laparotomy;
1. Impaired tissue perfusion with respect to tromboplebitis.
 Tromboplebitis postoperative usually occurs 7-14 days after surgery. Tromboplebitis great danger arises when the blood is separated from the walls of veins and join the bloodstream as emboli to the lungs, liver, and brain.
 Prevention tromboplebitis the postoperative leg exercises, and early ambulatif TED socks that the clients before trying ambulatif.
 
2. Intergriats bad skin in relation to wound infection.
 Wound infections often appear in 36-46 hours after surgery. The organisms that cause infections are most often stapilokokus aurens, organisms; gram positive. Stapilokokus resulted pernanahan.
 To avoid wound infection is the most important wound care with attention to aseptic and antiseptic.
 
3. Poor skin integrity with respect to wound dehiscence or eviserasi.
 Wound dehiscence is an open wound edges.
 Eviserasi injury is the release of internal organs through an incision.
 Factors causing dehiscence or eviserasi are wound infection, surgical error closing time, a heavy strain on the abdominal wall as a result of coughing and vomiting.
 

The process of wound healing
• The first phase
 Lasts up to 3 days. Trunk leucocytes much damaged / fragile. New blood cells develop into healing where nodes fibers are used as a framework.
 
• The second phase
 From day 3 to day 14. Charging by collagen, the entire periphery of epithelial cells arising perfect in 1 week. The new network is growing strongly and redness.
 
• The third phase
 Approximately 2 to 10 weeks. Collagen constantly dumped, new signage networks and muscles can be reused.
 
• The fourth phase
 Last phase. Healing will shrink and shrink.
 


Interventions to promote healing
1. Increase intake of foods high in protein and vitamin c.
2. Avoid anti-inflammatory drugs such as steroids.
3. Prevention of infection.

Returns physical function.
Returns physical function immediately after surgery with breathing and coughing exercises efektf, early mobilization exercises.

Maintaining self-concept.
Impaired self-concept: Body image can occur in patients with post-laparotomy due to a change in connection with surgery. Care interventions primarily aimed at giving psychological support, encourage clients and their close relatives to discuss the changes that occur and how they feel the patient after surgery.

Assessment
Supplies were performed in patients post-laparotomy, is;
1. Respiratory
• How is the respiratory tract, the type of breathing, the sound of breathing.
 
2. Circulation
• tension, pulse, respiration, and temperature, skin color, and capillary refill.
3. Nerve supply: The level of awareness.
4. Dressing
• Is there a tube, drainage?
• Are there any signs of infection?
• What is wound healing?
 
5. Equipment
• Monitor is installed.
• Intravenous fluids or transfusion.
6. Sense of comfort
• Pain, nausea, vomiting, patient positioning, and ventilation facilities.
7. Psychological: Anxiety, mood after surgery.

Nursing Diagnosis
1. Impaired sense of comfort, in connection with a strained abdominal pain in the abdomen.
2. Potential infection with respect to the incision / wound laparotomy.
3. Potential shortcomings caiaran connection with the fever, fluid intake a bit and spending a lot.

Evaluation Criteria
Expected results after postoperative patient care, include;
1. No there is pain during wound healing.
2. Normal incisional wounds without infection.
3. No complications arise.
4. Elimination pattern smoothly.
5. Patients remained in the optimal level without disabilities.
6. Losing weight or at least remain normal.
7. Before going home, patients know about:
• Advanced Medicine.
• The type of drugs given.
• Diet.
• Limit activity and plan activities at home.

Resource Library

Dr. Sutisna Hima (editor). Pathology Lecture collection. Faculty of medicine

Brunner / Sudart. Texbook of Medical Surgical Nursing IB Fifth edition. Lippincott Company. Philadelphia. 1984.

Soeparman, et al. Medicine: Hall Publisher Faculty of Medicine, Jakarta, 1987, Edition II.

MAINTENANCE MANAGEMENT
Assessment
The assessment includes objective and subjective.
1. Subjective data include;
• Pain was in the abdominal area.
 
2. Objective data include:
• Shallow Breath
• Tensions down
• Nadi faster
• Abdomen tense
• Defense positive muscular
• Sweating
• The sound of missing bowel
• liver dullness disappear

Nursing Diagnosis
1. Impaired sense of comfort, in connection with a strained abdominal pain in the abdomen.
2. Potential infection with respect to the incision / wound laparotomy.
3. Potential shortcomings caiaran connection with the fever, fluid intake a bit and spending a lot.

Results are expected
1. The patient will continue to feel comfortable.
2. Patient will maintain sterility of operation wound.
3. Patients will maintain fluid and electrolyte balance.

The act of nursing (nursing interventions) pre-operative:
1. Keep the patient to bedrest until the diagnosis is actually enforced.
2. Do not give anything by mouth and tell the patient not to eat and drink.
3. Monitoring fluid when administered intravenously.
4. Take note of the intake and output.
5. Position the patient as good as possible.
6. Collaboration with physicians for the provision of medicines.
7. Teach patient the things that need to be done after the surgery is completed.
8. Monitoring vital signs.

Postoperative nursing actions:
1. Monitor consciousness, vital signs, CVP, intake and output
2. Observation and record drain darai properties (color, amount) drainage.
3. In organizing and moving the position of the patient must be careful not to drain uprooted.
4. Sterile wound care.

Evaluation
1. Signs of peritonitis disappeared which include:
• Normal body temperature
• Normal Nada
• Abdominal bloating not
• Peristaltic normal bowel
• Positive flatus
• Bowel positive movement
2. Patients were free of pain and able to do the activity.
3. Patients were free of postoperative complications.
4. Patients can maintain fluid and electrolyte balance and restore the pattern of eating and drinking as usual.
5. Wound either.

Resource Library
Dr. Sutisna Hima (editor). Pathology Lecture collection. Faculty of medicine

Brunner / Sudart. Texbook of Medical Surgical Nursing IB Fifth edition. Lippincott Company. Philadelphia. 1984.

Soeparman, et al. Medicine: Hall Publisher Faculty of Medicine, Jakarta, 1987, Edition II.


May be useful ..................................

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