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Nursing Care Post op

A HEMICOLECTOMY is an operation to remove part of the large bowel (colon/intestine) because either it is not working properly or it is diseased.

POST OP CARE
Providing comfort preventing complications from major abdominal surgery promoting the return of bowel function. Monitor vital signs and drainage from wounds and drains for signs of hemorrhage and infection.

POST OP CARE
A nasogastric (NG) tube connected to low intermittent or continuous suction is usually present for gastric decompression until bowel sounds return. Note the amount and color of the gastric drainage, as well as the presence of abdominal distension.

POST OP CARE
Patients who require a colostomy return from surgery with an ostomy pouch system in place, as well as a large abdominal dressing. Observe the condition of the stoma every 4 hours.

POST OP CARE
A healthy stoma is beefy red and moist, whereas a dusky appearance could indicate stomal necrosis. A small amount of stomal bleeding is common, but any substantial bleeding should be reported to the surgeon.

POST OP CARE
The colostomy usually begins to function 2 to 4 days after surgery. After surgery, adjuvant radiation therapy to the abdomen or pelvis is used when there is high risk for local recurrence. Adjuvant chemotherapy (5-fluorouracil plus leucovorin) is used when there is high risk or evidence of metastatic disease. Radiation therapy and chemotherapy may be used as palliative measures to reduce pain, bleeding, or bowel obstruction in patients with advanced and metastatic disease.

POST OP CARE
Encourage the patient to verbalize fears and clarify the physicians explanation of diagnostic results. Dispel any misconceptions about the need for a permanent colostomy, and clarify the purpose of a temporary colostomy, if suggested. If a colostomy is to be performed, encourage the patient and her or his significant other to verbalize concerns about sexual functioning after surgery.

POST OP CARE
the presence of a stoma and a drainage pouch with fecal effluent can affect self-identity and sexual desires in both men and women After surgery, discuss methods to decrease the impact of the ostomy during intimate times. After surgery, help the patient avoid complications associated with bowel surgery. Assist the patient to turn in bed and perform coughing, deep-breathing, and leg exercises every 2 hours to prevent skin breakdown, as well as to avoid pulmonary and vascular stasis.

POST OP CARE
Teach the patient to splint the abdominal incision with a pillow to minimize pain when turning or performing coughing and deep-breathing exercises. Showing the patient pictures of an actual stoma can help reduce the shock of seeing the stoma for the first time. Allow him or her to hold the equipment, observe the amount and characteristics of effluent, and empty the ostomy pouch of contents or gas.

POST OP CARE
Take care when emptying or changing the pouch system not to contaminate the abdominal incision with effluent. Teaching the patient about home care of an ostomy can begin on the second or third postoperative day. Have the patient and a family member demonstrate ostomy care correctly before hospital discharge. Be alert to signs that indicate the need for counseling, and suggest a referral if the patient is not adjusting well.

DISCHARGE AND HOME HEALTH CARE GUIDELINES.


Teach the patient the care related to the abdominal incision Give instructions about when to notify the physician (if the wound separates or if any redness, bleeding, purulent drainage, unusual odor, or excessive pain is present). Advise the patient not to perform any heavy lifting (10 lbs), pushing, or pulling for 6 weeks after surgery. Teach the patient colostomy care and colostomy irrigation.

DISCHARGE AND HOME HEALTH CARE GUIDELINES.


Give the following instructions for care of skin in the external radiation field: 1. Tell the patient to wash the skin gently with mild soap, rinse with warm water, and pat the skin dry each day; 2. not to wash off the dark ink marking that outlines the radiation field; 3. to avoid applying any lotions, perfumes, deodorants, and powder to the treatment area; 4. to wear nonrestrictive soft cotton clothing directly over the treatment area;

DISCHARGE AND HOME HEALTH CARE GUIDELINES.


Give the following instructions for care of skin in the external radiation field: 5. to protect skin from sunlight and extreme cold. 6. Explain the purpose, action, dosage, and side effects of all medications prescribed by the physician. 7. Stress the need to maintain a schedule for follow-up visits recommended by the physician.

DISCHARGE AND HOME HEALTH CARE GUIDELINES.


Give the following instructions for care of skin in the external radiation field: 9. Encourage patients with earlystage disease and complete healing of the bowel to eat a diet consisting of a low-fat and high-fiber content with cruciferous vegetables (Brussels sprouts, cauliflower, broccoli, cabbage).

DISCHARGE AND HOME HEALTH CARE GUIDELINES.


10. Most colorectal tumors grow undetected as symptoms slowly develop. 11. Survival rates are best when the disease is discovered in the early stages and when the patient is asymptomatic. 12. Unfortunately, 50% of patients have positive lymph node involvement at the time of diagnosis. 13. Participation in procedures for the early detection of colorectal cancer needs to be encouraged. 14. Suggest follow-up involvement with community resources

BONE MARROW TRANSPLANT

Postoperative care:
Hold pressure for 5 to 10 minutes at the site; if oozing is still visible, repeat. Instruct the patient to lie on the site to maintain pressure. Transfer from operating room to recovery room until the patient recovers from anesthesia. The patients neurological and cardiopulmonary status needs to be carefully monitored during recovery from anesthesia.

Postoperative care:
Arrangement for same-day discharge or transfer to nursing unit if further observation is indicated. Most patients can be discharged soon after recovery, on the same day as donation.

Potential complications:
Anesthesia-related complications. These complications include respiratory and neurological problems. Bleeding from aspiration sites. Blood loss can lead to anemia and hypovolemia. Pain at aspiration site. Tenderness is expected, but severe pain may indicate hematoma formation or infection. Paresthesia (tingling or sharp pain radiating from the posterior iliac crest to the thigh and/or calf). This is caused by needle irritation or injury to the sacral nerve plexus during aspirations.