Effects of Gum Chewing on Post Operative Ileus

Mr. X was a male in his forties that presented to our medical-surgical floor post-operatively following a colectomy with a permanent colostomy placement. He was diagnosed with colon cancer and had several inches of his colon removed. He was present on the unit accompanied by his wife, who visited him with his three children frequently. He was engaging in numerous post-operative interventions such as deep breathing exercises, incentive spirometry use, early ambulation, pain management, deep vein thrombosis prophylactic treatment, and regular dressing changes. Additionally, close attention to the patient’s gastrointestinal assessment and surgical sites were considered. Patient education on colostomy care was also being initiated and routine nursing

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

It is normal for a patient to have absent or diminished bowel sounds after a postoperative ileus. Then nurse should ask the patient if they fell nauseous or feel like vomiting because if they do it should be addressed with antiemetic or prokinetic drugs. The nurse should assess for pain and avoid the use of opioid analgesics this will help by not prolonging but minimizing the duration of a postoperative ileus. The nurse should provide the patient with IV fluids until they can tolerate oral fluids to prevent dehydration and for the purpose of maintain fluid and electrolyte balance. The nurse should encourage early ambulation to promote peristalsis. Also, the nurse needs to assess the patient regularly to make sure they pass gas or have a bowel movement because this indicates the return of peristalsis which is a short term goal set for the patient. Once bowel sounds have returned the nurse should encourage the patient to resume to a normal diet to allow the return of normal peristalsis. Now, if the patient is not able to pass gas or have a bowel movement Bisacodyl (Dulcolax) suppositories may be given to stimulate peristalsis and promote the passage of gas or bowel

The patient will require surgery to repair the hole in the intestines, and subsequently will have a drainage tube, NG tube, and feeding tube. All drains will need to monitored for placement/movement, and drainage. Input and output will be closely monitored and recorded. The patient will remain on NPO, or nothing by mouth, to rest the bowels along with frequent assessments to monitor for infection and bleeding. The nurse will need to monitor for bowel sounds, vital sign changes, temperature changes, pain, abdomen girth, and wound/incision inspections. The following labs will require monitoring: CBC, H&H, albumin, BUN & creatinine, glucose, and ABG’s and lactic acid if sepsis is suspected. Careful and frequent monitoring of labs will alert the nurse if the patient develops sepsis, or hypovolemia due to excessive bleeding (Belinhof, et al., 2012). In addition to vital signs and labs, the nurse will also include patient assessment into consideration before drawing conclusions by means of critical thinking. After the full assessment has been made, the nurse will report any findings to the health care provider that require further investigation or

In the last five years, Enhanced Recovery After Surgery (ERAS) pathways for colorectal resection have been thrust into spotlight with evidence of expedited recovery time and improved postoperative outcomes1–5. However, there exists little uniformity in the recommendations and results of published ERAS pathways, and there is some evidence suggesting that the wrong cocktail of bundle elements can increase Surgical Site Infection (SSI) rates6. This inconsistency can be attributed to a lack of consensus on the efficacy of some common bundle elements, such as preoperative antibacterial showering, maintenance of normothermia, and high intraoperative Fraction of Inspired Oxygen (Fi02) 7–15. Such dissonance in studied ERAS efforts

In this paper I will be discussing preoperative fasting time for patients undergoing elective surgery with general anaesthesia. In clinical setting, nothing by mouth (NPO) after midnight is required on the day before scheduled surgery to prevent vomiting and aspiration of gastric content into the lungs. There are different preoperative fasting guidelines established by anaesthesiologist associations, for example the Canadian Anaesthesiologist’s Society (CAS) and American Society of Anaesthesiologists (ASA) (Tosun, B., Yava, A., & Açıkel, C. 2015). With these guidelines, fasting intervention is not just as simple as NPO after midnight. There was no evidence that showed shortened fast period increased patient’s risk for aspiration or

“The colon cancer vs. Crohn’s disease debate is generating a lot of interest in the medical community. Every year in the U.S., approximately 57,000 people die from colorectal cancer and 147,000 new cases are diagnosed”states Dr. Victor Marchione. Crohn's disease is a new disease that was introduced into today's society in 2015. 1.4 million Americans have Crohn’s disease or ulcerative colitis. Of those, about 700,000 have Crohn’s has been diagnosed in the years between 1992 and 2004 just from a doctor's visit. People have came up with different ways that we can help and prevent the disease such as Surgery, Conferences and “ KEY TO PROCESS “.

A medical diagnosis was a small distal bowel obstruction. The patient was NPO, on an NG tube, and IV fluids. The patient was also bipolar, which was a learning experience. The patient had an incision lower abdomen from umbilical region down to the pelvic region. It was approximately 10 cm. The nurse measured her NG to ensure it was in proper placement. She encourage the patient to eat ice chips to decrease cotton mouth. The nurse educated the patient on how ambulating will help the bowels to move and relieve abdominal pain. The nurse auscultated the patient’s bowel sounds to ensure the bowels were active. The nurse also had the patient use an incentive spirometer. This is to ensure the patient does not get pneumonia which would compromise the healing process. The nurse strongly encourage the patient to suck in air slowly through the mouth piece. The patient was able to such in 1000 for inspiratory volume. This was doubled from yesterday which was only 500. (Bunker Rosdahl, 2012)

My assessment of practice evidence for Term B is based on a case study of a particular patient during her perioperative journey from the ward before the surgery until she was ready to be sent back on the ward post operative on the 25th February, 2017. I followed a female patient who was having a surgical procedure called Laparoscopic Cholecystectomy. Cholecystectomy is the removal of the gall bladder and usually performed as a day case procedure. The operaion is carried out under a general anaesthetics. A telescope the width of a small finger is placed into the abdomen through a small cut at the navel. In order to create spare around the organs within the abdomen and provide the surgeon with a clear view it is necessary to use carbon

I learned more about what puts these patients at risk for impaired skin integrity, such as using soap around the peristomal skin when cleaning, accurately measuring before flange placement, and emptying the ostomy before it becomes any more than half full. In regards to nutrition, I learned that patients having an ileostomy are at risk for inadequate absorption of iron, magnesium, folic acid, fat, and vitamin B12. These patients are also at risk for an increased loss of water and sodium. They are more likely to develop stones in the kidneys and gallbladder as well. Knowing these details alerts me as to what nutritional supplementation and education the patient might need. For those with urostomies, I learned that it is necessary to monitor hydration status and to encourage the use of vitamin C or cranberry juice to decrease urine pH. This promotes a clean site around the stoma. Lastly, Schreiber’s article taught me more about the patient’s need for education and assistance (possibly financial) with caring for his or her own ostomy after discharge. Because the patient is likely to be discharged quickly, it is important to implement teaching and encourage the patient to share concerns. I am now aware also of education that can be beneficial in relation to body image and returning to one’s usual lifestyle.

Assess: Caroline Morris is a day five post-operative ileostomy patient with a thirty year history of ulcerative colitis. Her vital signs have been stable. She has been experiencing pain which she has rated an eight out of ten however, she refuses further pain medication. She is ready for discharge.

Details about the sample size, inclusion, exclusion, and the methods were appropriately stated and informed consent was given prior to the study. A statistical analysis was used to interpret the data by forming into table of the demographic, operative characteristics, and the clinical outcome (Jakkaew & Charoenkwan, 2012). The primary outcome was to measure the first passage of flatus and patients were instructed to report to flatus, defecation, and feeling of hunger and visual analog scores were used to measure the signs and symptoms of gastrointestinal disturbances (Jakkaew & Charoenkwan, 2012). The outcome assessor who was blinded to the study that helps eliminate the bias when collecting the data evaluated daily assessments. These methods were appropriate to measure the effects of gum chewing after surgery.

Outcomes is a difficult parameter to deal with.  I would say my average patient is in their middle to late seventies.  Since transitioning to Robotic assisted surgeries my incisions usually end up at about four centimeters in size for extrication of the specimen. This has markedly improved pain, we no longer require epidurals.  Instead we use local anesthesia blocks.  This decreases the LOS in the ICU.  This is part of an Enhanced Recovery After Surgery (ERAS) protocol which promotes clear protein drinks until two hours prior to the start of anesthesia.  With this we avoid nasogastric tubes, they are given gum to chew to help wake up their gastrointestinal system, we ambulate the patient on the same day as surgery.  We start feeding the clear protein drinks on the first day after surgery, minimize the amount of narcotics, and advance them to walking and eating on a regimented schedule.    Once the patient is eating a regular diet, ambulating and passing bowel movements and pass a Physical Therapy assessment, they are deemed stable for discharge.  For the readmission issues, we seem to have issues with the cardiac service.

The notion that hyperglycemia may still play a major role in post op colectomy for cancer patients therefore increasing their risk of morbidity and mortality was further explored in 2012. This study explored the relationship of hyperglycemia to general surgery outcomes by studying the association of operative day and postoperative day 1-blood glucose levels with survival outcomes after colectomy (Jackson, R., Amdur, R. 2012). A retrospective analysis was conducting between 2000-2005 using the Veterans Affairs Surgical Quality Improvement Program database, linked with Veterans Affairs Decision Support System Blood Glucose values.