Appendicitis Pre- and Post-Operative Care Plan

Appendicitis Pre- and Post-Operative Care Plan

Surgical Nursing  

Appendicitis Pre Operative Care:

• Sonde installation to decompress the stomach.
• Catheters to control urine production.
• Rehydration.
• Antibiotic with broad spectrum and is given intravenously.
• Fever-reducing medicines.
• If fever, should be reduced before anesthesia.

Appendicitis Operative Care :

• Appendectomy
• Appendix removed, if the appendix is perforated freely, then the abdomen was washed with physiological saline and antibiotics.
• Appendix abscess treated with IV antibiotics, its mass may shrink, or abscess may require drainage within a few days.
• Appendectomy done if the abscess performed elective surgery after 6 weeks to 3 months.

Appendicitis Post Operative Care:

• Observation of vital signs.
• Lift the stomach sonde when patients have realized that aspiration of gastric fluid can be prevented.
• Put the patient in a semi-Fowler position.
• Patients are said to be good when it is in 12 hours without any disturbance, during fasting.
• When the action is bigger operation, for example the perforation, fasting continued until bowel function returned to normal.
• Give drink from 15 ml / hour, for 4-5 hours, then raised it to 30 ml / hour. The next day give food strain, and the next day be given soft foods.
• One day after surgery the patient is advised to sit upright in bed for 2 × 30 min.
• On the second day the patient can stand and sit outside the room.
• Day 7 stitches can be removed and the patient allowed to go home.

In the appendix to the state of the masses who are still active inflammatory process that is characterized by:

• General state of the client it still looks sick, the body temperature is still high.
• Local examination of the right lower quadrant of the abdomen are still clear signs of peritonitis.
• Laboratory there are leukocytosis and the counts are shifting to the left.

Surgery should be performed as soon as the client is prepared, because it feared would happen appendix abscess and generalized peritonitis. Preparation and surgery should be done as well as possible given the complications of wound infection is higher than surgery in simple appendicitis without perforation.

On the state of the appendix mass with inflammatory process has subsided characterized by:

• General condition has improved with no visible pain, body temperature is not high anymore.
• Local inspection abdomen there are no signs of peritonitis and only clear and palpable mass with mild tenderness.
• Laboratory leukocyte count and differential count normal.

Actions taken should be conservative with antibiotics and bed rest. Surgery if the bleeding was more difficult and more, especially when mass appendix has formed more than a week since the attacks of abdominal pain. Surgery is carried out immediately if the treatment occurs abscess with or without generalized peritonitis.

Urinary Retention related to Benign Prostatic Hyperplasia (BPH)

Urinary Retention related to Benign Prostatic Hyperplasia (BPH)

Urinary Retention  

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi.

BPH involves hyperplasia (an increase in the number of cells) rather than hypertrophy (a growth in the size of individual cells), but the two terms are often used interchangeably, even amongst urologists.

Urinary retention

Incomplete emptying of the bladder

Defining Characteristics:

Measured urinary residual >150 to 200 ml or 25% of total bladder capacity;
obstructive lower urinary tract symptoms (poor force of stream, intermittency of stream, hesitancy of urination, postvoiding dribbling, feelings of incomplete bladder emptying);
irritative lower urinary tract symptoms (urgency to urinate, diurnal frequency of urination, nocturia);
overflow incontinence (dribbling urine loss caused when intravesical pressure overwhelms the sphincter mechanism)


Nursing Care Plan for Benign Prostatic Hyperplasia (BPH)

Nursing Diagnosis : Urinary Retention related to mechanical obstruction, enlarged prostate, decompensated detrusor muscle.

Goal:

• Urination by a considerable amount, with no palpable bladder.
• Shows post-voiding residual of less than 50 ml in the absence of droplets / excess flow.

BPH Nursing Intervention and Rational:

1. Encourage clients to urinate every 2 to 4 hours.
R /: Minimizing excessive retention of urine in the bladder.

2. Observation of the flow of urine. Note the size of the force.
R /: Useful for evaluating obstruction and intervention options.

3. Supervise and record time, the number of each micturition. Note the decrease in spending and changes in urine specific gravity.
R /: Urinary retention increases the pressure in the upper urinary tract that can affect the kidneys.

4. Encourage drinking water to 3000 ml / day.
R /: Increased flow of fluid to maintain renal perfusion and kidney cleanse, bladder from bacterial growth.

5. Perform catheterization and perianal care.
R /: Reduce the risk of ascending infection.

Deficient Knowledge related to Laparotomy

Deficient Knowledge related to Laparotomy

Surgical Nursing  

Nursing Care Plan for Laparotomy - Nursing Diagnosis : Deficient Knowledge


A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as celiotomy. (wikipedia)

Deficient Knowledge

Absence or deficiency of cognitive information related to a specific topic

Defining Characteristics:

• Verbalization of the problem;
• inaccurate follow-through of instruction;
• inaccurate performance of test;
• inappropriate or exaggerated behaviors (e.g., hysterical, hostile, agitated, apathetic)

Nursing Diagnosis for Laparotomy : Deficient Knowledgerelated to lack of information, do not know the source of information.

Outcomes:

• Reveals an understanding of the disease process and treatment.

Interventions and Rational :

1. Review the procedure and postoperative expectations.
R /: To provide basic knowledge of where the patient can make an informed choice.

2. Discuss the importance of adequate fluid intake, dietary needs.
R /: Increases healing and normalization of bowel.

3. Demonstrate belutan wound care or appropriate.
R /: Increases healing, reduce the risk of infection, providing an opportunity to observe the wound.

4. Revisit gastrotomi hose care when the patient is discharged with this tool.
R /: Increase the independence, improve self-care skills.

5. Identify signs that require medical evaluation, fever settled, swelling, erythema, artau opening the wound edges, change drainage characteristics.
R /: Early recognition of complications and immediate intervention can prevent progression of the situation serious, life-threatening.

6. Encourage gradual increase in activity in accordance tolernsi and balance with adequate rest periods.
R /: Prevent fatigue, stimulate circulation and normalizing organ function, improve healing.

Anxiety related to Laparotomy

Anxiety related to Laparotomy

Surgical Nursing  

Nursing Care Plan for Laparotomy - Nursing Diagnosis : Anxiety


A laparotomy is a surgical incision (cut) into the abdominal cavity. This operation is performed to examine the abdominal organs and aid diagnosis of any problems, including abdominal pain. In many cases, the problem – once identified – can be fixed during the laparotomy. In other cases, a second operation is required. Another name for laparotomy is abdominal exploration.

Anxiety

A vague, uneasy feeling of discomfort or dread accompanied by an autonomic response, with the source often nonspecific or unknown to the individual; a feeling of apprehension caused by anticipation of danger. It is an altering signal that warns of impending danger and enables the individual to take measures to deal with threat.

Defining Characteristics:

Behavioral

• Diminished productivity;
• scanning and vigilance;
• poor eye contact;
• restlessness;
• glancing about;
• extraneous movement (e.g., foot shuffling, hand/arm movements);
• expressed concerns resulting from change in life events;
• insomnia;
• fidgeting

Affective

• Regretful;
• irritability;
• anguish;
• scared;
• jittery;
• overexcited;
• painful and persistent increased helplessness;
• rattled;
• uncertainty;
• increased wariness;
• focus on self;
• feelings of inadequacy;
• fearful;
• distressed;
• apprehension;
• anxious

Physiological

• Voice quivering

Objective

• Trembling/hand tremors; insomnia

Subjective

• Shakiness; worried; regretful

Nursing Diagnosis for Laparotomy : Anxiety related to surgical procedure, preoperative procedures.

Outcomes:

• Patients will demonstrate the ability focus on new knowledge and skills.
• Identification of symptoms as an indicator of anxiety itself.
• Showed no aggressive behavior.
• Communicating and handling negative feelings appropriately.
• Relaxed and comfortable in the move.

Interventions and Rational :
1. Monitor patient's signs and symptoms of anxiety while nursing assessment.
R /: Assessment of patients with anxiety conditions carefully allows nurses to make nursing priorities.

2. Focus discussion on stressors that affect the condition of the patient.
R /: Focus discussion facilitates the ability of the patient to express fears and feelings are felt and build a therapeutic relationship.

3. Discuss the patient's perception will be a surgical procedure, the fear associated with the operation.
R /: Discussion will make the patient's perception and fear to express themselves and explore self-knowledge.

4. Provide information procedure before surgery, the patient's illness and surgery preparation
R /: Measures to increase knowledge and anxiety reduction.