Short Modest Proposal

The preoperative phase begins when the decision to have surgery is made. It is used to assess the patients suitability for surgery, identify potential risk factors, educate the patient on avoiding complications of surgery and anaesthesia, and plan to meet the patients needs for a safe and sustained recovery upon discharge (Berman, 2014, p. 1015). This process includes addressing all parameters on the preoperative checklist. Fasting is an important part in the preoperative phase. Preoperative fasting is the practice of a patient abstaining from oral food and fluid intake for a certain amount of time before a surgical procedure is performed. This is intended to prevent pulmonary aspiration of stomach contents during general anaesthesia. When

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

Yes, there are not a lot of foods to break down, plus the food is not broken down in the stomach naturally, so fewer nutrients are absorbed through the intestine. The stomach mechanically breaks down, and the bolus mixes with the secretions so the nutrients can be absorbed by the intestine because the foods weren’t properly being broken down, the digestive tract has been altered and it interferes with the absorption of vitamins and nutrients. The small intestine is the major site for chemical digestion and absorption and with the surgery affecting the intestine; the walls with the absorptive cells that absorb nutrients are disrupted.

There seem to be an increasing application of Roen-en-Y gastric bypass today by some surgeons. This is a restrictive procedure that has minimal mal-absorption issues and it makes part of an array of bariatric surgeries. However, the most commonly used procedure is biliopancreatic diversion or Scopinaro, which have been used for more than two decades and are popular in with many surgeons more so in the developing countries. This process is intended to inhibit absorption of fat in a bid to trigger massive weight loss in patients who are morbidly obese. It restricts gastric thereby diverting bile and pancreatic fluids to the distal ileum (Consensus Development Conference Panel, 1991). This procedure therefore exposes a limited area of small bowel for the absorption of nutrients that need biliary and pancreatic fluids. The procedure and its variations are still common as indicated above including; biliopancreatic diversion with duodenal switch, which also result in malabsorption. It is however noted that most patients who undergo this procedure also experience severe protein and fat related malabsorption problems.

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

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

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.

Bowel cancer is the second leading cancer in Australia with over 90 % of whom over 50 years old (Bowel Cancer Australia, 2014). Every year, over 17,000 people are newly diagnosed with bowel cancer (Cancer Council Australia, 2015). The most common treatment for all stages of bowel cancer is removing the cancer and forming a stoma which may help people to maintain the maximum function of their digest system. Depending on the patient’s situation, the colostomy can be reversed to recover the function of absorb nutrition and exclude metabolites. This paper will review the whole process of a patient who received reversal colostomy from admission to discharge, and explain the symptoms that the patient had post operation.

The upper part of the stomach will be pulled up to the esophagus and attached with stitches (sutures). A procedure may be done to widen the opening of the stomach to the small intestine (vagotomy). This will help the stomach empty after surgery.

Identify the preoperative fasting time and the acceptance of nutritional supply until the third postoperative day.

The patients were selected according to the type of surgery, open colectomy for left-sided colon and rectal cancer, patients that required "postoperative ventilation or planned intensive care therapy due to co-morbid conditions were excluded from the study," the eligible subjects were randomly selected to either the control or treatment group, and peri-operative treatment was standardized (Quah et al, 2006, p. 65). Outcome measures were time to first flatus and feces, and length of hospital stay, and a blinded "independent specialist colorectal nurse practitioner" evaluated the progress (Quah et al, 2006, p. 65). Researchers utilized the Mann-Whitney U-test and the X2 test to analyze the data entered into statistical software, and measured statistical significance using a two-sided p value of 0.05. The two groups were homogeneous "in terms of age, gender co-morbid disease, history of previous abdominal surgery, site of tumor and tumor stage" (Quah et al, 2006, p. 65). The researchers findings were not significant enough to support the intervention; the mean time to first flatus was 2.7 days for the control group and 2.4 days for the experimental group a p value of 0.56, the mean time to first feces was 3.9 days for the control group and 3.2 for the experimental group a p value of 0.38, and length of hospital stay was 11.2 days for the control group and 9.4 days for the experimental group a p value of 0.75. Patients in the experimental group had

The perioperative preparation of the patient involves the patient will need to do a bowel prep to clean the stool out of the colon. The patient will not eat or drink anything after midnight the evening before surgery. The patient will meet with the anesthesiologist. The doctor will discuss general anesthesia. This will

Unfortunate as it may be, postoperative nausea still affects approximately 22% to 38% of people undergoing a surgical procedure (Chandrakantan, 2011). The pathological process associated with nausea and vomiting includes “the central nervous system, autonomic nervous system, gastric dysrhythmias, and the endocrine system” (Singh, Yoon, & Kuo, 2016, p. 100). This activation causes increased activity, which can be unpleasant for the patient particularly after undergoing surgery. A surgical patient who is experiencing postoperative nausea and vomiting (PONV) may have increased risks such as aspiration or choking, increased pain, and delayed healing. In order to possibly reduce these risks, physicians and nurses should be educated on the most up

Mrs. D is a 3 week post colectomy patient that has been readmitted to the hospital with severe dehydration. She has been struggling with proper nutrition and ostomy care since her discharge post-surgery. Our goal with Mrs. D should be to rehydrate her and provide her with patient education on the importance of proper nutrition and on ostomy care. After she has been rehydrated with intravenous fluids and proper nutrition she could benefit from possibly skilled nursing facility placement for continued education for proper nutrition and ostomy care depending of her activity level and if she can tolerate making her own meals or do her own ostomy care she may could benefit from home health care

Tappenden et al. (2013) stated that regardless of body mass index, hospitalized patients typically suffer from undernutrition due to a variety of reasons. These include, but are not limited to: NPO diet order for diagnostic and therapeutic procedures, inadequate oral food and beverage intake due to illness-induced poor appetite, meal disturbances, inadequate assistance at mealtimes, reduced ability to chew or swallow, unnecessary hold of enteral feeds due to residuals or drug administration, as well as gastrointestinal symptoms often caused by medications (Tappenden et al., 2013). Interrupting feeds due to drug administration contributes significantly to malnutrition in hospitalized patients, as holding feeds can be cumulative and prolonged, therefore patients often do not receive nor maintain their recommended goal rate, subsequently compromising their nutritional status (Williams, Leslie, Leen, Mills & Dobb, 2013). Patients may also