Surgical Procedures

Cholecystectomy Definition Cholecystectomy is a surgical procedure to remove your gallbladder. Cholecystectomy may be necessary if you experience pain from gallstones that block the flow of bile. Cholecystectomy is a common surgery, and it carries only a small risk of complications. Indications     Gallstones in the gallbladder (cholelithiasis) Gallstones in the bile duct (choledocholithiasis) Gallbladder inflammation (cholecystitis) Pancreas inflammation (pancreatitis)

Risks          Bile leak Bleeding Blood clots Death Heart problems Infection Injury to nearby structures, such as the bile duct, liver and small intestine Pancreatitis Pneumonia

Procedure Open Cholecystectomy     A 5- to 8-inch right or midline incision is made in the abdomen, and the abdominal cavity is opened to expose the gallbladder. The artery to the gallbladder and the cystic duct leading from it are tied off and cut, and the gallbladder is removed. Before the abdomen is closed, drains may be placed under the liver and in the bile duct. The drains, which are kept in place from 4 to 10 days, are removed after x-ray studies show there are no more stones.

Nursing Responsibilities Preoperative            Assess client’s fears, anxieties, support systems and patterns of coping. Establish trusting relationship with client. Explain routine procedures and allow the patient to ask questions. Ask the patient if she might be pregnant. Ask what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription. Ask the patient to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs he is taking that make it hard for the blood to clot. Do bowel and bladder preparations. Instruct the patient not to eat or drink anything after midnight the night before surgery as prescribed by the doctor. Advise the patient to shower the night before or the morning of the surgery. Accomplish the pre-op checklist. Prepare to administer preoperative medications as prescribed.

Intraoperative         Greet and identify patient and introduce yourself. Prepare the necessary instruments, gowns, sponges, and others. Assist the surgeons, assistants and the rest of the surgical team. Watch the field and anticipate the surgeon’s needs in terms of instruments, sutures, sponges, and others. Hand over sterile instruments in a decisive and positive manner. Keep the instruments as clean as possible. Maintain sterile technique. Observe the 15 principles of asepsis. Count the sponges, instruments, visceral packs and needles.

Postoperative       Monitor patient’s airway Monitor vital signs Assess effects of anesthetic agents Assess the patient for complications Provide comfort and relief Teach patient self-care.

Cesarean Section

Definition A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. After healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth later. Indication
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Health problems in the mother The position of the baby Not enough room for the baby to go through the vagina Signs of distress in the baby

Risks
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Infection of the bladder or uterus Injury to the urinary tract Injury to the baby Placenta previa Placenta growing into the muscle of the uterus and has trouble separating after the baby is born (placenta accreta) Uterine rupture Reactions to medications Problems breathing Bleeding Blood clots in the leg or pelvic veins Infection

Procedure      After the patient have received cesarean section anesthesia, a catheter (plastic tube) will be placed in your bladder to drain your urine during the surgery. The lower abdomen is then washed with a special disinfectant cleanser, and will be covered with sterile sheets. The surgeon will make a 6- to 8-inch incision in the abdomen directly over the uterus. The incision can be either horizontal or vertical. Once the surgeon is inside, another incision will be made through the uterus. In most women, the incision is side to side on the lower part of the uterus. The baby is then delivered through this opening. The umbilical cord is cut, and the baby is handed to a healthcare provider to be cleaned, dried and checked by a doctor.

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After the baby has been delivered, the placenta will be carefully removed from the uterus. At this time, the patient may also receive a drug that causes the uterus to contract and helps prevent serious bleeding. The doctor will then close the incision on the uterus, and the incisions in the skin will be closed with surgical staples or stitches that will later dissolve on their own.