Surgical Procedures Assignment
Added on 2020-05-16
20 Pages5183 Words218 Views
Running head: Nursing-surgical careNURSING-SURGICAL CAREName of the StudentName of the UniversityAuthor Note
1Nursing-surgical care1A. Surgical Procedures that result in a stoma: 1a (i): abdominoperineal resection (apr). In this surgical procedure, parts of the GItract like the Anus, rectum and sections of sigmoid colon are removed via an incision in theabdomen. In this process, the end of the intestine is connected to the stoma called colostomy,or the opening in the abdomen, through which the bodily wastes are collected in a disposablebag, placed outside the body. Cancerous lymph nodes can be removed in this surgery(Cancer.gov, 2018).Here the surgeon first divides the blood vessels supplied to the colon and rectum, afterwhich the sigmoid colon and rectum is freed from the surrounding tissues, and then removedfrom the rest of the large intestine. After preparing the colon and rectum for removal, theperineal region (between the legs) is operated to remove the anus, after which the anus, alongwith the colon and rectum is removed from the body.1a (ii): low anterior resection (lar).Low Anterior Resection (LAR) surgery is used inthe treatment of rectal cancer. In the procedure, the cancerous part of the rectum is surgicallyremoved; the remaining portion of the rectum is connected back to the colon to enable normalmovement of bowel. The surgery can be done by two different techniques, depending on thenumber and type of incisions made of the abdomen:Open Surgery: In this technique, a long incision is made on the abdomen (or belly),and the cancerous part of the rectum is removed through this incision.Minimally Invasive Surgery: Here many small incisions are made in the abdomen,through which surgical instruments and a video camera is inserted, to remove thecancerous part of the rectum. Robotic devices can be used in this procedure by thesurgeons to help with the surgery.
2Nursing-surgical careAfter the removal of the cancerous part of the rectum, the remaining part of the rectum isconnected back to the colon using stitches or metal staples. The region where the two ends ofrectum and colon are connected is known as the anastomosis (Mskcc.org, 2018).1a (iii): proctocolectomy. Total proctocolectomy with ileostomy is a surgical procedurein which the entire large intestine and rectum is removed (Medlineplus.gov, 2018). The surgical procedure can either be an open surgery or laparoscopic surgery (also called keyhole procedure). The complete colon, rectum and anus are removed, and are also called a Pan-Proctolectomy. The blood and vessels and lymph nodes associated the part of the bowel are also removed. Along with the abdominal incisions, another incision is made near the bottom, to remove the anus. The rest of the bowel (consisting of the small intestine) is utilized to make an ilesotomy on the right side of the abdomen. The complete surgical procedure takes approximately three to four hours. (Birminghambowelclinic.co.uk, 2018).1a (iv): hartmann’s procedure. In this surgical procedure, part of the sigmoid colonand/ or the rectum is removed. It is generally performed on patients suffering from bowelcancer or diverticular diseases (Birminghambowelclinic.co.uk, 2018). The surgery can be either done laproscopically or as open surgery. In the process, the bowel is made free from the surrounding attachments from the abdominal cavity, followed bythe division of blood vessels. After this, the bowel is incised, and the segment that is diseasedis then removed. The colon is the brought to the surface of the skin, and is stitched to it, to form a colostomy. The rectum is closed using stitches or staples and placed back in the pelvicregion. This surgery can be reversed by another surgery later on (Sussexsurgical.co.uk, 2018).1a (v) cystectomy. The procedure can be of different types, like:
3Nursing-surgical careradical cystectomy. Where the bladder and the fatty tissues around it is removed witha wide margin. The nearby pelvic organs (like prostrate in case of male patients, uterus andpart of vaginal wall in case of female patients) are also removed. It is used for invasive oradvanced cancer of the bladder (Kcurology.com, 2018).After the removal of the bladder, urinary diversion is done to restore the continuity ofurinary tract. The urinary diversion can be of three types: Neobladder (connecting a newbladder to existing urethra), Continent Diversion (ureters connected to pouch withcatherizable stoma) and ileal Conduit (short segment of small intestine connecting ureters toskin)Partial Cystectomy. Here a part of the bladder is removed, while preserving the rest ofthe bladder. It is utilized in case of benign lesions on the wall of bladder (Kcurology.com,2018).Simple Cystectomy. Here the entire bladder is removed, but the adjacent fatty tissueand pelvic organs are preserved (Kcurology.com, 2018). Thus, the prostrate, seminal vesiclesand urethra in male and urethra, uterus and anterior wall of vagina in female is left intact.This also keeps potency conserved (Urology.ucla.edu, 2018).1a (vi) pelvic Excenteration.Anterior Pelvic Excentration. In this surgery, organsfrom the urinary and gynecologicsystem are removed, in order to treat cancer in the cervix orother organs in the urinary or gynecologicsystem (Mskcc.org, 2018). This procedure can beperformed if irradiation therapy has failed (atlasofpelvicsurgery.com, 2018). The bladder andurethra is removed and hence a new place is needed for the elimination of urine. Urinarydiversion is created for collecting the urine, and can be either is in the form of ileal conduit orurinary pouch. The ovaries, fallopian tubes and uterus are also removed (mskcc.org, 2018).
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