Exploratory Laporatomy

What is Exploratory Laparotomy?

It is an operation where a cut is made into the abdomen.

A method to explore the abdomen, a diagnostic tool that allows physicians to examine
the abdominal organs.

Indication

Abdominal pain of unknown origin. In addition, bleeding into the abdominal cavity is
considered a medical emergency such as in ectopic pregnancies.

To determine the source of pain and perform repairs if needed

To examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes,
bladder, and rectum) for evidence of endometriosis.

Contraindications

Bleeding

Infection

Failure to find the cause of the problem; more surgery or other treatments may be
needed

Poor healing of the incision

Damage, injury, or problems with the bowels

Risks of anesthesia

What to expect before the procedure (Pre-Op)

The doctor will do pre-operative evaluation in the clinic 1 week before the procedure (if
not an emergency case).

Patient may need to undergo some routine tests before your operation example. heart
trace (ECG), x-ray and blood tests for cardio-pulmonary clearance.

Patient will be admitted a day before the scheduled procedure.

Consents must be secured

NPO for 8 hours prior to the time of the procedure

If ordered by the physician, cleaning or fleet enema will be given for further bowel
preparation.

Insertion of Intravenous Line

Diagnostic exams as ordered by the physician like Complete blood count, blood typing,
urinalysis and ultrasound.

Pre-operative medicines and antibiotics will be administered.

Instructions regarding change of gown, removal of jewelries, dentures, contact lenses,

hair accessories, nail polish and make up will be given.

An hour before the scheduled operation, patient will be wheeled down to the delivery
room.

Abdominoperineal prep (shaving) will be done.

What to expect during the procedure (Intra-Op)

Prior to the time of operation, patient will be wheeled in to the operating room where a
surgical nurse will do the necessary preparations such as placement of cardiac leads,
hooking to the cardiac monitor, oxygen administration thru nasal cannula, and placement
of leggings.

Patient's obstetrician will probably meet him/her in the operating room where an
anesthesiologist will be ready.

Prior to the procedure, for verification that the right patient and right procedure will be
done, Signing in will be called, wherein the patient will be asked to state in his/her full
name, date of birth, name of his/her surgeon and anesthesiologist, as well as the
procedure to be done.

After the introduction of anesthesia, a curtain will be raised over the patient's mid section
and his/her arms will be outstretched in order for the anesthesiologist and nurse to have
access to his/her I.V.

A Foley catheter will be inserted. This is not a painful procedure, and if you have an
anesthesia in you, you won't feel it at all. Then the surgical nurse will clean the incision
site with betadine.

Once an adequate level of anesthesia has been reached, the initial cut into the skin will
be made. The surgeon will then explore the abdominal cavity for disease.

Alternatively, samples of various tissues and/or fluids will be removed for further analysis
and will be sent to the laboratory for microscopic examination.

The surgeon will then close the incision.

What to expect after the procedure (Post-Op)

After the operation, you will be wheeled into recovery where you will be observed for two
hours as the anesthetic wears off.

You will be hooked to the cardiac monitor to check your vital signs, and you will also be
hooked to the oxygen.

Post-operative medicines will be given to you. Depending upon the nature of your
surgery and your doctor's assessment of your pain, you probably will be given a pain
drip to address the pain.

The foley catheter will remain until further orders.

After the recovery period, you will be transferred to your room if there are no
complications.

Turning from side to side is advised. An abdominal binder is applied to support your cut.

Eat nothing per mouth or take only sips of water or clear liquids or as ordered by your
physician on the first day of operation or until flatus passed out.

Discharge instructions and wound care will be given to you by your bedside nurse.

At home:

During the first two weeks, avoid tiring activities such as lifting heavy objects.

Slowly increase your activities. Begin with light chores, short walks, and some driving.
Depending on your job, you may be able to return to work.

To promote healing, eat a diet rich in fruits and vegetables.

Try to avoid constipation by:

o

Eating high-fiber foods

Drinking plenty of water

Using stool softeners if needed

Take proper care of the incision site. This will help to prevent an infection.

Follow your doctor's instructions

Contact the doctor if any of the following occurs:

Fever or chills

Redness, swelling, increasing pain, excessive bleeding, or any discharge from the
incision site

Increasing pain or pain that does not go away

Your abdomen becomes swollen or hard to the touch

Diarrhea or constipation that lasts more than 3 days

Bright red or dark black stools

Dizziness or fainting

Nausea and vomiting

Cough, shortness of breath, or chest pain

Pain or difficulty with urination

Swelling, redness, or pain in your leg

Source:
http://www.makatimed.net.ph/main.php?id=412
Esophagogastroduodenoscopy
What is Esophagogastroduodenoscopy?

It is also known as Upper GI Endoscopy or Gastroscopy. It is a

diagnostic procedure wherein a small camera is inserted down
the throat to directly see the esophagus, stomach and the
upper part of the small intestine (duodenum). It can be done
with or without sedation (depending on you)

Indications

Performed to check possible symptoms of gastrointestinal disease such as

dyspepsia, Heartburn, persistent vomiting, difficulty swallowing, loss of appetite, weight

loss, vomiting of blood, black stools, or anemia.

It can also be used to examine the status of a previously known gastrointestinal disease.

How to prepare for an EGD

NPO for 8 hours before the procedure.

Aspirin and other blood thinners (Warfarin, Clopidogrel, Cilostazol, Heparin) are stopped
for several days before the procedure to lessen the risk of bleeding.

Bring an adult companion to assist you after the procedure.

Before the procedure, an informed consent will be obtained from the patient.

The doctor explains the indications, nature, and relevant details as well as the risks,
benefits, alternatives, and complications of the procedure to the patient.
Note: procedure usually takes about 30 minutes.

What happens before an EGD?

1. Anesthesia
After enough fasting, a local anesthetic (Lidocaine) is sprayed to the back of the
throat to prevent coughing or gagging when the endoscope is inserted.
Midazolam (Versed) - provides moderate sedation and relieves anxiety during
the procedure
Atropine - to reduce secretion
Glucagon - to relax smooth muscle
2. Patient will be requested to bite on to a mouth guard to protect his/her teeth.
3. Positioning.
lateral position | Rationale: to facilitate clearance of pulmonary secretions and
provide smooth entry of the scope
4. The endoscope is lubricated with a water-soluble lubricant.
5. Insertion of endoscope down the throat until it reaches the duodenum.
Careful examinations of the esophagus, stomach, and the duodenum are
made. Oftentimes, a painless biopsy sample is taken through the endoscope
using a small forceps to test for bacteria or to be sent for microscopic
examination.
What happens after an EGD?
1. The patient will be brought to the recovery area.
2. Assessment
level of consciousness, vital signs, oxygen saturation, pain level, and monitoring for
signs of perforation (ie, pain, bleeding, unusual difficulty swallowing, and rapidly
elevated temperature)
3. After the patients gag reflex has returned, if the patient is having some throat
discomforts, patient may be given one of the following:
Lozenges
saline gargle
oral analgesic agents
Note: The patient will not be allowed to eat or drink anything until his/her gag reflex
returns to prevent choking.
What are the possible complications of EGD?

It is generally safe and well-tolerated. Complications may occur but are very, very rare.

Low oxygen levels

low blood pressure

low heart rate

allergic reactions may be due to sedation

respiratory problems such as stridor or aspiration

pneumonia may occur but are very uncommon

bleeding may occur from a biopsy site

perforation or tears is more associated with therapeutic Endoscopy and is very

uncommon.

anything unusual noted after EGD should be immediately reported to the physician

Source:
Brunner and Suddarth's Textbook of Med.-Surg. Nursing 12th ed. (2 vols.) - S. Smeltzer,
et al., (Lippincott, 2010) BBS
http://www.webmd.com/digestive-disorders/upper-endoscopyd
http://emedicine.medscape.com/article/1851864-overview
http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/esophag
ogastroduodenoscopy_92,P07717/

Assignment in Competency Appraisal

Research Topics:
EGD (Esophagogastroduodenoscopy)
Exploratory-Laparotomy

Submitted by:
Group 5
Mary Jane Balino
Alyssa Chryss Braa
Mary Joy Jarin
Mary Anthony Lao
Wilfred Nacional

Submitted to:
Melted Sales, RN, MAN
CA II Lecturer

February 01, 2016