A Laparoscopic Cholecystectomy Was Indicated Nursing Essay

A Laparoscopic Cholecystectomy Was Indicated Nursing EssayCholecystitis is defined as an inflammation of the g all in allbladder caused most commonly by the obstruction of the cystic duct Bloom et al., 2012. The gallbladder is a small organ laid under the liver that plays a major role in the digestion of dilate (Balentine, 2012). Normally bile and digestive enzymes pass out of the gallbladder on their way to the small intestine. If this flow becomes blocked, it will build up inwardly the gallbladder, causing swelling, upper type AB pain, and gallstones resulting in liver dysfunction (Bloom et al, 2012 Mackillop Williamson, 2010).Gallstones be solid p names that argon formed from bile (Balentine, 2012). Common risk factors in the formation of gallstones include being female of childbearing age, overweight, certain medications much(prenominal) as birth control pills or statins, rapid weight loss, shortsighted dietary habits and pregnancy (Ali, Cahill, Watson, 2004 Balentine, 20 12 Mackillop Williamson, 2010). Gallstones nooky block the outflow of bile and digestive enzymes from the pancreas. If this blockage persists, the gallbladder can become inflamed causing cholecystitis (Balentine, 2012).The sign treatment of cholecystitis includes bowel rest, intravenous hydration, analgesia and antibiotics (Bloom et al., 2012). Out persevering management may be desirable however if functional treatment is indicated, laparoscopic cholecystectomy represents the gold standard of accusation (Bignell et al., 2011 Chowbey et al., 2010 Farkas et al, 2012 Tsimoyiannis et al., 2009). In the diagnostic process for surgical interventions an ultrasound scan may be performed however charismatic resonance cholangio-pancreatography (MRCP) is the diagnostic preference for gallstones (Mackillop Williamson, 2010). MRCP is a non-invasive technique used for viewing the bile and pancreatic ducts and gallbladder using magnetic resonance imaging (MRI) (Mackillop Williamson, 2010) .Laparoscopic cholecystectomy requires gas to be administered into the peritoneal cavity and indeed routinely requires general anaesthesia with intubation (Sherwinter, 2011). The advantage of laparoscopic cholecystectomy results from preserving the integrity of the abdominal wall which reduces running(a) trauma and complications. It also has been shown to construct a greater recovery m decreases postoperative pain and the need for postoperative analgesia, shortens infirmary stay and returns the enduring to full activity inwardly 1 hebdomad (Sherwinter, 2011 Tsimoyiannis et al., 2009).For the operation anaesthesia was induced with fentanyl, midazolam, propfol and rocuronium. Tracheal intubation was facilitated with suxamethonium. Anaesthesia was kept up(p) with a propofol infusion accompanied with a nitrous oxide and oxygen ventilation. Mrs smith was also given 4mg of ondansetron onward the end of surgery for the prevention of post-operative nausea and vomiting and was admi nistered bupivacaine into all trocar wound sites. At the conclusion of the surgery Mrs smith was administered glycopyrrolate and neostigmine to antagonize the residual neuromuscular blockage and pain remainder was given via fentanyl pain protocol.After induction of anaesthesia Mrs Smith was positioned in the reverse Trendelenberg with the correct side of the table elevated. Abdominal insufflation was achieved with CO2 and intra-abdominal squash was maintained at approximately 13 mm Hg (Gupta et al., 2007 Shora et al., 2008 Tsimoyiannis et al., 2009). Intra operative monitoring included electroencephalogram (EEG), pulse oximetry, blood pressure and centerfield rate via arterial line, and temperature (MacKay, Sleigh, Voss Barnard, 2010 Shora et al., 2008)One clinical issue related to Mrs Smiths perioperative care is strategies to avoid wrong-site surgery. Safe surgery is a world-wide recognised issue (WHO, 2009). health care and surgical care provision encompass such a stagecoa ch of variation and complexity that it involves an enlarged risk of errors (Weiser et al., 2010). These increased risks are cod to multifaceted issues of human error where there is a breakdown in discourse or processes (Brady, 2009).The WHO Surgical Safety Checklist is designed to enhance twain communication and teamwork and to safeguard that healthcare professionals deliver evidence based patient care (Anderson 2009). The surgical base hit tinklist identifies three forms of an operation the sign in time out and sign out. Each point corresponds to a particular proposition period in the normal flow of work. A checklist coordinator, usually the go nurse, ensures that the surgical team has completed the listed tasks before continuing onto the next phase (WHO, 2008)The sign in period is before the induction of anaesthesia (WHO, 2008). This is where the patient confirms to operating room rung, their identity, type and site of operation (in their own words), and confirms their e ulogy for the procedure by acknowledging their signature on the consent form. The anaesthesia safety check is also completed within this phase. This check asks questions relating to allergies, make-up or nail polish, dentures or prosthesis, time bladder sound emptied and the time that the last food and fluid where consumed. It likewise checks identification band, and whether the operative site has been tag by doctor (Queensland Health, 2011). The sign in phase allows for the checklist to not exclusively be a to do list. It ensures that important safety identifiers have been look into and collated correctly (Karl, 2009). It permits a logical and systematic approach aligning with the organizations values, highlighting patient safety and recognising individual roles in ensuring patient safety within the multidisciplinary partnership. This phase also emphasises an institutions regulatory requirements that essentially breaks patient care (Conley et al, 2011).The here and now phase is the time out. This occurs before skin incision (WHO, 2008). Operating staff actively confirm differing team members roles. The surgeon, anaesthesia professional and nurse verbally confirm the patient, type and site of the operation to be performed and visually check for a valid consent. For the nursing team it is also a time to review sterility and equipment (WHO, 2008). Brady (2009) reports that wrong site surgery is the second highest among all sentinel events recorded. He attributes faulty communication and organizational culture as factors contributing to sentinel events and endorses strategies such as surgical safety checklists, that increase the effectiveness of team functioning.The third phase of sign out is initiated before the patient leaves the operating room (WHO, 2008). The checklist coordinator confirms with the team the name of the procedure recorded, that the surgical count is correct, the specimen is labelled accurately and if there were any equipment problems ne eding to be addressed (WHO, 2008). This period again emphasises improve communication among surgical team members and thus quality of care (WHO, 2012). According to Kao and Thomas (2008, as cited in Jones, 2011) surgical errors such as wrong site surgery can be attributed to individuals as opposed to one individual. By this constant communication and clarification at certain time periods doneout an operation demonstrates improved communication where potential risks where minimised (Jones, 2011).Jones (2011) also claims that with the WHO checklist, interaction between team members have improved and potential risks minimised. Surgical safety checklists not only improve communication and teamwork, but also improve understanding of each others roles (Bell, 2010). This dodging can achieve massive reductions in complications and studies indicate that a checklist whole kit because it is more than just a tick sheet. With the effective adoption it more often than not requires local syst em changes and a commitment to teamwork for safety (WHO, 2012).Checklists are adjudge as an organised system for a safe ending to a task. Research has suggested that at least half of all surgical errors are avoidable (Weiser et al (2010). If used properly the WHO Surgical Safety Checklist, through effective teamwork and communication will result in the right patient, having the right procedure, at the right time in the right area (Donaldson 2008).Sherwinter, D. A. (2011). Laparoscopic Cholecystectomy. Retrieved from http//emedicine.medscape.com/article/1582292-overviewQueensland Health (2011). Perioperative Patient Record. Retrieved from http//www.health.qld.gov.au/psq/pathways/docs/pre-op-check-a3-11.pdf