N-Trivia
| Circumcision Posted: 29 Sep 2010 06:48 PM PDT 
 Circumcision Definition - The excision of the foreskin (prepuce).
Discussion - Circumcisions are commonly performed on the male infant at birth or shortly thereafter. However, the uncircumcised adult may experience difficulty in retracting the prepuce from the glans of the penis because of a stricture (phimosis), which requires surgical intervention, or circumcision may be performed to treat recurrent balanitis or as a religious rite.
- If performed on an infant, the procedure may take place in a separate part of the newborn nursery, aseptically suited for the procedure.
Positioning - Supine, with legs slightly apart, or lithotomy.
- Children and infants may be placed in a frog-leg position or on a specially designed board.
Incision Site - Circumferentially around the glans penis.
Packs/ Drapes - Child: Pediatric Lap sheet
- Adult: Laparotomy pack
- Infant: Pediatric Lap sheet or folded towels
Instrumentation - Infants and children: Pediatric Lap tray
- Circumcision lamp
- Adults: Minor/ very fine tray, Probe and groove director.
Supplies/ Equipments - Basin set
- Blades
- Needle counter
- Catheter
- Gauze roll and impregnated gauze strips
- Solutions
Procedure - If phimosis is present, a dorsal slit is made. Adhesions are lysed.
- A circumferential incision is made at the reflection of the foreskin, which is then excised.
- Hemostasis is achieved, and the wound edges are approximated using absorbable suture.
- For a very young infant, the skin edges are usually not approximated.
- A strip of nonadherent gauze is placed around the incision and is covered with a gauze roll dressing.
- A piece of umbilical tape may hold the gauze roll in place.
- No other dressing is usually necessary.
Perioperative Nursing Considerations - Consider the special needs of the Jewish patient for a ritual circumcision. All female team members may be asked to leave the room during the procedure.
- Instruct the patient the proper way of cleansing the wound.
image from islandcrisis.net Related posts: - Vasectomy
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| Vasectomy Posted: 29 Sep 2010 06:40 PM PDT 
 Vasectomy Definition - Excision of a segment of the vas deferens with ligation of distal and proximal ends.
Discussion - This procedure is performed as an elective sterilization procedure or to prevent orchitis prior to a prostectomy.
- It can be performed under local, regional, or general anesthesia and as an out patient procedure.
Positioning - Supine, with legs slightly apart
Incision Site Packs/ Drapes - Laparotomy pack or basic pack with transverse Lap sheet.
Instrumentation - Vasectomy tray or minor tray.
Supplies/ Equipment - Basin set
- Blades
- Suction
- Solutions
- Sutures
- Scrotal support (optional)
Procedure - The vas deference is palpated through the scrotum before anesthesia (local) is administered.
- A small incision is made in the scrotum.
- The vas is seized with an Allis or Bobcock clamp and is freed of surrounding tissue.
- A segment of the vas is excised and the ends are ligated or cauterized.
- The ends may be nuried within the scrotal fascia with one or two sutures.
- The procedure is repeated on the other side, and the incision is closed in layers.
Perioperative Nursing Considerations - Local anesthesia is frequently used.
- An ice pack may be applied to the scrotum immediately after surgery.
- A sterilization permit may be needed in addition to the operative consent.
image from myfloridaurology.com Related posts: - Colostomy
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| SalpingO Posted: 29 Sep 2010 06:33 PM PDT 
 Salping0-Oophorectomy Description - The removal of one (unilateral) or both (bilateral) fallopian tubes and corresponding ovary.
Discussion - This procedure may be performed in conjunction with a hysterectomy or as a separate procedure. As a separate procedure, it is usually performed for a variety of nonmalignant diseases that include acute and chronic infection, cysts, tumors, and hemorrhage owing to tubal pregnancy. Malignancy of a tube or ovary will usually necessitate a hysterectomy with excision of the opposite adnexae.
Position - Supine, with arms extended on armboards.
Instrumentation - Major tray or abdominal hysterectomy tray.
- Internal stapling instruments.
- Self-retraining retractor.
Supplies/ Equipment - Basin set
- Blades
- Needle counter
- Suction
- Solutions – saline, water
- Sutures
Procedure - The abdomen is entered through a low midline or Pfannenstiel incision, depending on the size of the patient and the known pathologic condition.
- The peritoneal cavity is entered and a self-retaining retractor is placed in the wound.
- The operating table is placed in slight Trendelenberg position, and the incision is packed with moist Lap sponges.
- The uterus is grasped with a tenaculum or uterine elevator, and if adhesions are present, the affected tube and ovary are isolated from surrounding organs.
- The tube(s) are grasped with one or two Babcock clamps. Two Kelly or uterine clamps are then placed across the ovarian vessels.
- The tissue is divided between the clamps with a knife, dissecting scissors, or cautery pencil. Internal staples can also be used to accomplish this task.
- The infundibulopelvic ligament is ligated and divided, as is the broad ligament attached to the tube and ovary. The tube and ovary are excised.
- If internal staples are not used, a suture ligature is used to ligate the ovarian vessels.
- This procedure is repeated on the other side (if bilateral).
- The raw surface of the ovarian ligaments left by the dissection are reperitonealized using a running suture.
- The wound is irrigated with warm saline, and closed in a routine fashion.
Perioperative Nursing Considerations - For bilateral surgery, a sterilization permit may be required in addition to the operative permit.
- When the specimen is collected (if bilateral), each side should be labeled and in separate containers, depending on hospital policy.
image from lifescript.com Related posts: - Anastomosis of Small Intestine (Small Bowel Resection)
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