N-Trivia
| Iridectomy Posted: 19 Oct 2010 08:42 PM PDT 
 Definition
Excision of a section of the iris. Discussion - This procedure is usually indicated for primary angle-closure glaucoma, secondary angle-closure glaucoma, and occluded angle glaucoma.
- The creation of a new communication or channel for aqueous chamber is the basic goal of the procedure.
- To relieve the papillary block and reestablish the flow of aqueous through Schlemm's canal.
Positioning - Supine position, slightly elevated or flat.
- Arms are tucked and with soft restraints.
Drapes/ Packs - Ophthalmic packs
- Special eye fenestrated sheet
- Basic pack
- Head or neck pack
Instrumentation - Basic eye procedure tray
- Glaucoma procedure tray
- Handgrips or drape for microscope
Suppplies/ Equipment - Headrest
- Sitting stool with backrest
- Microscope or loops
- Basin set
- Ophthalmic sponges
- Blade
- Multipore filter
- Cautery
- Balanced saline solution
- Medication
- Sutures
Procedure - A small periotomy (2 mm) is made at the superior limbus.
- The epithelium is scraped away from the corneoscleral junction.
- Preplaced sutures are placed in the cornea.
- Prolapse of the iris is facilitated by gentle traction of the sutures.
- The iris is grasped, and the excision is performed.
- Balanced saline solution is used to flush away the remaining pigmented epithelium.
- The preplaced sutures are tied. Additional sutures may be necessary.
- Topical corticosteroids and antibiotic ointment may be instilled, and an eye pad is applied.
Perioperative Nursing Considerations - Patient education is important, since the majority of patient's will recuperate at home without the aid of direct nursing supervision.
- Written materials, audiovisual presentations, and formal education sessions in which questions and / or concerns can be addressed will alleviate anxiety associated with surgical event.
- Allow the nurse to strengthen any postoperative instruction for the patient and family.
- The patient should be well informed about the specific agents prescribed during the recovery period and notify the physician concerning any problems associated with the agents.
Related posts: - Cataract Extraction
- Vasectomy
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| Repair Of Intestinal Obstruction Posted: 19 Oct 2010 08:32 PM PDT 
Definition  Reestablishment of intestinal patency in nay number of conditions that create a blockage of the intestinal tract.
Discussion - Intestinal obstruction is the most frequent gastrointestinal emergency requiring immediate surgical intervention in the newborn.
- Symptoms may include emesis, abdominal distention, and failure to pass flatus and meconium.
- The repair of an intestinal obstruction may include:
- Untwisting of a volvulus.
- Division of intestinal band.
- Release of an internal hernia.
- Resection of bowel with anastomosis.
- Creation of an intestinal stoma.
- Surgical intervention should be performed within the first few hour of life, since delay may severely increase the risk of major complications.
Positioning - Supine, with arms restrained at the side.
Packs/ Drapes - Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.
Instrumentation - Pediatric laparotomy tray
- Hemoclip
Supplies/ Equipment - Thermal blanket with control unit
- Thermal sheets, head covering
- Basin set
- Handheld cautery
- Blades
- Needle counter
- Dissector sponges
- Solutions
- Sutures
Procedure - The abdomen is open through an appropriate incision related to the anatomic area that is obstructed.
- With atresia or stenosis, the entire bowel is examined to rule out multiple areas of involvement.
- For duodenal artresia, a paramedian or transverse incision is made in the upper abdomen.
- Bypass of the obstructed duodenal segment is usually preferred over resection.
- An antecolic duodenojejunostomy is usually the procedure of choice, in which a loop of the proximal jejunum is brought anterior to the transverse colon and to the side of the distended proximal duodenum.
- A side to side anastomosis is fashioned in one or two layers according to the surgeons preference and size of the small jejunal lumen.
- The abdomen is closed in a routine fashion.
Perioperative Nursing Considerations - Separate all instruments associated with the anastomosis and follow bowel technique protocol.
- Check all equipment to promote safety and avoid prolonging anesthesia.
- Patient needs to be prepared physically and mentally.
- Circulator should confirm the operative side with the patient.
Related posts: - Inguinal Hernia Repair
- Repair Of Tracheoesophageal Fistula
- Repair of Omphalocele
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| Repair Of Tracheoesophageal Fistula Posted: 19 Oct 2010 08:25 PM PDT 
 Definition
The restoration of esophageal continuity (esophageal atresia) and the repair of an abnormal connection between the trachea and the esophagus (tracheoesophageal fistula). Discussion - Esophageal atresia, which may or may not be associated with fistula, may develop during the first 3 to 6 weeks of life. The most common fistula occurs at the upper segment of the esophagus, ending in a blind pouch with the lower segment of the esophagus connected by a fistula to the trachea.
- Prompt surgical intervention may prevent respiratory and eating difficulties. It may be necessary to perform a gastrostomy first, to decompress the air-distended stomach.
Positioning - Lateral; right side up; a small pillow is placed between the legs, left leg is straight, right is flexed.
Packs/ Drapes - Pediatric laparotomy sheet
- Plastic adherent sheet
Instrumentation - Pediatric laparotomy tray
- Pediatric thoracotomy tray
- Hemoclip
- Small bone cutter
Supplies/ Equipment - Thermal blanket
- Positioning aids
- Basin set
- Suction
- Scale (to weigh sponges)
- Blades
- Needle counter
- Vessel loops
- Infant chest drainage unit
- Chest tube
- Hemoclips
- Bone wax
- Solutions
- Sutures
Procedure - If a transpleural approach is used, a right posterolateral incision is made over the fifth rib and the pleura are entered via the fourth intercostal space.
- The mediastinal pleura are incised and the lower esophagus is exposed and mobilized.
- The tracheoesophageal fistula is transected, closed, and tested for air leaks by filling the chest with a small amount if saline.
- Depending on the diameter and thickness of the upper and lower muscular wall segments, esophageal continuity is established by one of several one-or-two layer technique.
- A small gastrostomy feeding tube may be passed transnasally into the esophagus, across the anastomotic site, into the stomach for postoperative feeding.
- A chest tube is positioned, and the incision is closed.
- If the chest is entered retropleurally, a chest tube is not required, but a small Penrose drain may be inserted close to the anastomosis and brought out through the lateral corner of the wound.
Perioperative Nursing Considerations - When transferring a patient with a chest tube, keep the closed drainage system below body level.
- Use strict aseptic technique during the procedure.
- During the procedure, instruments used must be isolated in a basin.
Related posts: - Repair of Omphalocele
- Repair Of Intestinal Obstruction
- Inguinal Hernia Repair
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