Postoperative Nursing Care Research Articles

선호 음악요법이 복강경 자궁적출술 환자의 수술 후 통증, 불안 및 회복실 체류시간에 미치는 효과

Purpose: This study examined the effects of music therapy on pain, anxiety and length of stay of patients undergoing laparoscopic hysterectomy in the postanesthesia care unit (PACU). Methods: Sixty patients who received laparoscopic hysterectomy under general anesthesia from a PACU in a university hospital located in Cheonan city participated in this study. The experimental group (n = 30) was offered the option to listen to their preferred music by using MP3 players and headphones for 30 minutes. The control group (n = 30) received routine postoperative nursing care. Visual analogue scale was used to measure participants’ pain and anxiety, length of stay in the PACU was examined by using their medical records. Data were collected from December 2013 to February 2014 and analyzed by descriptive statistics, χ 2 -test, Fisher’s exact test, and independent t-test using SPSS version 21.0. Results: The result showed that the level of post-operative pain (t = 2.44, p = .018), anxiety (t = 2.37, p = .021), and the length of stay in PACU (t = 3.06, p = .004) significantly decreased in the experimental group as compared to the control group. Conclusion: This study indicated that music therapy with the patients’ preferred music showed positive effects. Therefore, it can be used as a therapeutic intervention for postoperative pain management of patients with laparoscopic hysterectomy.

Analysis of changes of intraocular pressure and nursing for vitrectomy with silicone oil tamponade technique

Objective To explore the changes of intraocular pressure and nursing for vitrectomy with silicone oil tamponade technique. Methods Clinical data of 52 patients(52 eyes) with silicone oil tamponade after vitrectomy were retrospectively analyzed and made a summary of nursing care. Results There were 24 patients(46.2%)with high intraocular pressure,and there were 19 patients high intraocular pressure occurrence within 2 weeks. There were no significant differences in sex, age, duration, the amount of refraction and silicone oil tamponade between high and normal intraocular pressure groups(P> 0.05). Conclusion The early high intraocular pressure is common after vitrectomy with silicone oil tamponade technique.Patient's condition observation should be strengthened and prevent from post- operation complications. Key words: Vitrectomy; Silicone oil; Intraocular pressure; Post-operative nursing care

Effect of Nursing Intervention Guidelines on Nurses’ Role, Patients’ Needs, and Visual Problems Post Cataract Surgery

In Egypt, cataract is the major cause of blindness of the population aged 65 years or older. Inadequate postoperative nursing care may lead to serious complications for the patient with cataract surgery. The aim of this study was to evaluate the effect of the use of nursing guidelines on nurses’ knowledge and practices and on their achievement of patients’ needs post cataract surgery. This quasi-experimental pre-post assessment study was carried out on 34 nurses working at the outpatient clinics and ophthalmology departments in El Ramad Hospital, Rod El Farag, Cairo, affiliated to Ministry of Health and 34 patients undergoing cataract surgery in the setting. Data collection tools were a self-administered questionnaire and an observation checklist. The researcher developed nursing guidelines based on analysis of the data collected in the assessment phase to provide nurses with guides for care of cataract patients after surgery. The evaluation of the guidelines’ effects on nurses' knowledge and practice, and consequently on patients' needs was carried out immediately after implementation (post-test), and 3 months after (follow-up). The results showed statistically significant improvements in nurses’ knowledge and practice at the post and follow-up tests (p<0.001), with statistically significant strong positive correlation (r=0.714) between them. Also, there were statistically significant improvements in all areas of patient needs after implementation (p<0.001). In multivariate analysis, the intervention was a statistically significant independent positive predictor of the improvement in nurses’ knowledge and practice, and of patients’ needs. In conclusion, implementing nursing guidelines for care of cataract patients after surgery is effective in inducing improvements in nurses’ related knowledge and practice, which better achievement of patients' needs. It is recommended that these guidelines be used in similar settings. Further research is proposed to investigate the effect of the implementation of these guidelines on decreasing the incidence of complications after the surgical technique.

Study of problems arising during perioperative care of postoperative endophthalmitis.

To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis. The medical records of 34 patients (35 eyes) presenting with infectious endophthalmitis at Zhongshan Ophthalmic Center, Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery. Thirty-four patients (35 eyes) developed complications of infectious endophthalmitis after surgery. Thirty-three cases were successfully cured and only one patient (1 eye) was untreated due to Pseudomonas aeruginosa infection. Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.

Assessing pain and emotional wellbeing in feline patients with chronic kidney disease

Pain is both a sensory and emotional experience and can be measured with the use of pain scoring charts. Pain scoring is seen as a valuable tool especially as an aid to post-operative nursing care. Currently pain scoring systems are designed for assessing acute post-operative pain and have been validated for use in dogs. However they can be useful in assessing pain experienced in cats suffering from diseases such as chronic kidney disease, and can assist the nursing care provided to patients hospitalised for treatment of the disease. Patient care could be improved if a more holistic approach to nursing was adopted which encouraged veterinary nurses to not only consider the physical aspects of pain but also the emotional side.

Nursing of femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus

Objective To explore the nursing of patients with keratoconus after performing the deep anterior lamellar keratoplasty assisted by femtosecond laser .Methods 9 patients with keratoconus hadfemtosecond laser-assisted deep anterior lamellar keratoplasty . Adequate preoperative , intraoperative and postoperative nursing care was performed .Results All the patients were satisfied with the results of sugery and their visual acuity were improved for various status .The purpose of treatment was achieved .One patient had intraoperative complication of small descemet membrane perforation .Conclusions Our early results of femtosecond laser-assisted deep anterior lamellar keratoplasty turn to be safe and effective .The key nursing care of preoperative period is to help patients make ophthalmic examination related to parameter settings of femtosecond laser , and the intraoperative period is to help patients coordinate with surgery and closely observe the changes of patients .The instructions of discharge and follow-up are also the important parts of consolidation the therapy outcomes . Key words: Nursing; Keratoconus; Femotosecond laser; Deep anterior lamellar keratoplasty

Effect of comprehensive psychological intervention in relieving pain in floating women underwent induced abortion

Objective To explore the effect of comprehensive psychological intervention on painrelieving and comfort-enhancing in floating women who underwent induced abortion operation.Methods A total of 160 floating women who underwent induced abortion were randomly divided into observation group and control group.In observation group,comprehensive psychological intervention was conducted,including preoperative health education,relaxation exercise,music intervention and postoperative nursing care in semi-Fowler' s position; while in control group,the routine procedure of postoperative nursing care in horizontal position was performed.The levels of pain and comfort of two groups were compared.Results There was significant difference in pain-relieving between two groups (P ＜ 0.05).In terms of comfort,the physiological and psychological dimensions in observation group were significantly better than those in control group (P ＜ 0.05).Conclusion Comprehensive psychological intervention can relieve floating women' s pain and enhance their comfort while undergoing induced abortion operation. Key words: Comprehensive psychological intervention; Induced abortion; Pain-relieving; Research

Procedure-specific pain management and outcome strategies.

Optimal dynamic pain relief is a prerequisite for optimizing post-operative recovery and reducing morbidity and convalescence. Procedure-specific pain management initiative aims to overcome the limitations of conventional guidelines and provide health-care professionals with practical recommendations formulated in a way that facilitates clinical decision making across all the stages of the perioperative period. The procedure-specific evidence is supplemented with data from other similar surgical procedures and clinical practices to balance benefits and risks of each analgesic technique. There is emphasis on the use of multimodal analgesia and preventive analgesia aimed at reducing central sensitization. Importantly, the benefits of dynamic pain relief may only be realized if other aspects of perioperative care such as the use of minimally invasive surgery, approaches to reduce stress responses, optimizing fluid therapy and optimizing post-operative nursing care with early mobilization and oral feeding are utilized.

Local anaesthesia – Part 3: regional anaesthesia of the pelvic limb

ABSTRACT:Regional anaesthesia is more commonly used on the pelvic limb than on the thoracic limb. It has potential complications and side effects but can allow us to provide the most effective form of analgesia for many patients for whom it might otherwise be difficult to manage their pain. Part three of this series reviews the local anaesthesia techniques available for the pelvic limb, including epidurals, and the postoperative nursing care these patients will require.

Does EuroSCORE Predict intensity of Postoperative Care and Rehabilitation Parameters? A Prospective Evaluation

Objective: An increasing number of elderly and multi-morbid patients undergo cardiac surgery which results in increased postoperative morbidity, prolonged Intensive Care Unit (ICU) length of stay (LOS) and higher hospital costs. We aimed to evaluate the model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the prediction of ICU LOS, hospital LOS, required daily nursing effort, and the type of cardiac rehabilitation. Methods: Prospective observational evaluation of 505 consecutive adult patients (mean age 65.1 ± 12.1 years, 25.7% female) who underwent cardiac and/or thoracic aortic thoracic surgery with Cardiopulmonary Bypass (CPB). Results: Median additive and logistic EuroSCORE was 5 (Interquartile Range (IQR) 3-7) and 5.8 (IQR 2.6-14.1), respectively. In univariate analysis both additive and logistic EuroSCORE were significantly associated with prolonged ICU LOS, prolonged hospital LOS, higher daily nursing effort, and the type of cardiac rehabilitation (inpatient versus outpatient), p<0.001 for all correlations. Multivariate analysis including other clinically relevant variables (CPB duration, type of operation, age, Body Mass Index (BMI), urgency of surgery, Left Ventricular Ejection Fraction (LVEF)) showed higher additive EuroSCORE and higher logistic EuroSCORE, independently associated with prolonged ICU LOS, prolonged hospital LOS, and higher daily nursing effort. However, EuroSCORE did not independently predict the type of rehabilitation. Conclusion: The EuroSCORE model can be used to identify patients with elevated risk for prolonged ICU LOS, prolonged hospital LOS and higher intensity of postoperative workload, and it is predictive for the type of rehabilitation. This conclusion may contribute to optimize the management of hospital bed capacity as well as a systematic planning of ICU resources, postoperative nursing care and cardiac rehabilitation.

Transcatheter Aortic Valve Implantation Options For Treating Severe Aortic Stenosis in the Elderly

Severe calcific aortic stenosis (AS) is a progressive cardiac disease that predominantly affects elderly adults. The hallmark symptoms of AS include exertional dyspnea, angina, and syncope. Adults of advanced age do not usually seek treatment for symptoms until their quality of life is greatly diminished. The 2 standard treatments for severe AS are open aortic valve replacement and percutaneous valvuloplasty. As adults age, their comorbid medical conditions often make them too high of a surgical risk for traditional aortic valve replacement, and percutaneous valvuloplasty, although less invasive, often produces only temporary relief of AS symptoms. To provide severe AS patients with alternative less risky treatment options in their later years, transcatheter aortic valve implantation (TAVI) devices were developed. Through this overview of the disease progression of AS and the different TAVI devices and the insertion procedures, a better understanding of the initial postoperative nursing care associated with postoperative TAVI patient management will be achieved.

Tracheostomy with emphasis on perioperative nursing care

Tracheostomy is an important life-saving procedure performed by many surgical specialties. The indications for tracheostomy are vast, most commonly for the relief of upper airway obstruction, uncontrolled tracheobroncheal secretions, obstructive sleep apnea and prolonged intubation due to respiratory insufficiency. Placement of a tracheostomy tube allows long term airway access and allows for removal of translaryngeal endotracheal tube (ETT tube). A brief discussion of anatomy and physiology, tracheostomy types, complications and post operative nursing care will be described.

What Immediate Post-Operative Nursing Care Contributes to a Better Patient Outcome After a Child has had a Day Surgery Tonsillectomy and Adenoidectomy (T&A)?

Current immediate postoperative nursing care of T&A patients includes: pain management, oral intake of fluid and other comfort measures such as ice collar or humidified oxygen. Some nurses encourage patients to drink fluids while others wait for the patient to have the desire to drink. Pain management may also vary. Some patients are given routine medication for pain while others are given pain medication PRN. Some nurse use ice collar therapy because they recognize the benefits while others feel it causes too much agitation.

Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series

The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions. Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8-67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management. Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues. Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.

Care of Patients With Deep Inferior Epigastric Perforator Reconstruction

Recent trends reflect greater numbers of women opting for mastectomy for invasive breast cancer. Breast reconstruction, either at the time of mastectomy or later, is increasingly an option patients prefer. Although many women opt for implants, reconstruction using autologous tissue offers several advantages including tissue that feels more natural and will age naturally with the patient. The deep inferior epigastric perforator flap has emerged as an alternative to the transverse rectus abdominis myocutaneous flap and allows for preservation of the underlying abdominal muscle. As greater numbers of surgeons are able to offer this microvascular alternative, nurses will care for these postoperative patients in the intensive care unit and medical/surgical settings. This article reviews the evaluation of patients for deep inferior epigastric perforator reconstruction and the unique complexities of postoperative nursing care for these patients.

Effects of health education pathway for low rectal cancer patients with laparoscopic anus-preserving operation

Objective To explore the effects of health education pathway for low rectal cancer patients with laparoscopic anus-preserving operation.Methods A total of 72 patients were investigated with self-designed health education path and knowledge needs scale.Preoperative adequate psychological care and intestinal preparation were done,postoperative nursing care for pipeline was done and the complications were observed and cared.Results Defecation function of all the cases recovered well,the occurrence rate of complaints was low,trauma was small and the stay days in hospital were shortened.Conclusions Health education for patients with rectal cancer can improve the patients'enthusiasm on the rehabilitation,be benefit for patients recovery and the improvement of quality of life. Key words: Health education; Laparoscopic; Low rectal cancer; Anus-preserving operation

Postoperative Anxiety and Depression in Patients Undergoing Thoracoscopic Closure of Congenital Heart Defects

Thoracoscopic closure of atrial or ventricular septal defect is a new surgical method. The postoperative mental health status of patients treated with this novel approach is presently unknown. The aims of this study were to compare psychological symptoms between patients treated with thoracoscopy and those treated with conventional open heart surgery and to evaluate the effect of perioperative counseling on postoperative psychological symptoms. In this prospective study, 120 patients were divided into thoracoscopic and conventional open heart surgery groups. All patients received standard preoperative and postoperative nursing care. The thoracoscopic group was randomized into study (n = 30) and control (n = 30) groups. The thoracoscopic study group received daily counseling 2 days before and within the first 4 days after the surgery. Psychological symptoms were assessed by Symptom Checklist-90 on day 5 after the surgery. There was no statistically significant difference in baseline characteristics or Symptom Checklist-90 scores between the thoracoscopic and conventional surgery groups (P > .05) or between the thoracoscopic study and control groups (P > .05). After surgery, the mean scores of somatization, anxiety, depression, and phobic ideation in the thoracoscopic control group were lower than in the conventional surgery group (P < .05). The mean scores of anxiety, depression, and phobic ideation in the thoracoscopic study group were lower than in the thoracoscopic control group (P < .05). Thoracoscopic closure of congenital heart defects is associated with less postoperative anxiety or depression symptoms compared with conventional open heart surgery. Perioperative counseling in patients undergoing thoracoscopic closure reduces postoperative anxiety or depression symptoms and should be conducted in all patients before the surgery.

Classifications of Urinary Diversions

Advantages and disadvantages of different types of urinary diversion and their choices are of utmost importance for the functional outcome and patient satisfaction. There is a variety of choices for incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent urinary diversion, continent cutaneous urinary diversion, and urethral bladder substitution). The choices may be limited by patient criteria and/or medical criteria. Important patient criteria are preference, age and comorbidity, BMI, motivation, underlying disease, and indication for cystectomy. PERIOPERATIVE NURSING DESCRIPTION AT BRICKER INTERVENTION/ILEAL CONDUIT Teaching the patient with a newly formed stoma, but who also has low vision to manage his/her stoma independently, can be a difficult task. Practical tips on pre- and post-operative nursing care of the patient with a newly formed stoma are provided for the nurse. In some cases, unfortunately, complications may occur following stoma-forming surgery; these are discussed and nursing advice provided. One of the most important ways in which the nurse can support the patient is to teach the patient his/her stoma care, ensuring independence before discharge and showing empathy. There is still no conclusive evidence that any type of urinary diversion offers superior HRQOL (Health-related Quality of life) outcomes. In fact, though postcystectomy patients commonly experience urinary and sexual problems, HRQOL remains good irrespective of the method of urinary diversion. Future research should utilize the validated bladder cancer specific HRQOL instruments and perhaps explore the impact of pre-operative counseling on post-operative HRQOL.

Choosing one-and two-piece appliances

Nursing and Residential CareVol. 14, No. 8 Clinical ReviewChoosing one-and two-piece appliancesRebecca SlaterRebecca SlaterSearch for more papers by this authorRebecca SlaterPublished Online:16 Aug 2013https://doi.org/10.12968/nrec.2012.14.8.410AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Baker M, Greening L (2009) Practical management to reduce and treat complications of high output stomas. Gastrointestinal Nursing 7(6): 10–7 Link, Google ScholarBlack PK (2000) Holistic Stoma Care. Balliere Tindall, London Google ScholarBecker HP, Willms A, Schawb R (2007) Small bowel fistula and the open abdomen. Scandinavian Journal of Surgery 96(4): 263–71 Google ScholarBurch J (2005) The pre-and postoperative nursing care for patients with a stoma. Br J Nurs 14(6): 310–8 Link, Google ScholarBurch J, Sica J (2004) Colostomy Products: an update on recent developments. Br J Community Nurs 9(9): 482–6 Link, Google ScholarBurch J, Slater R (2012) Enhanced recovery after surgery: benefits for the stoma care patient. BrJ Nurs 21(6): S16–21 Link, Google ScholarCronin E (2008) A guide to the appropriate use of convex stoma care products. Gastrointestinal Nursing 6(2): 12–6 Link, Google ScholarHall C, Myers C Phillips RKS (1995) The 554 Ileostomy. Br J Surg 82(10): 1383–5 Crossref, Google ScholarHerlufsen P, Olsen AG, Carlsenet al. (2006) Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs 15(16): 854–62 Link, Google ScholarSkipper G (2002) Esteem one-piece closed pouch in the management of stomas. Br J Nurs 11(21): 1412–5 Link, Google ScholarSlater R (2012). High output stomas: difficulties with a large laparostomy wound. Br J Nurs 20(16): stoma care supplement Google ScholarStoma Care Nurses High Impact Action Steering Group (2010) High impact action for stoma care. oloplast, Peterborough Google ScholarWesler M, Riedlinger I, Prause U (2009). A comparative study of two-piece ostomy appliances. BrJ Nurs 18(9): S30–8 Google Scholar FiguresReferencesRelatedDetailsCited byPractical guidance for nurses caring for stoma patients with long-term conditions4 February 2016 | British Journal of Community Nursing, Vol. 21, No. 2Improving ostomates’ confidence with a discharge-solidifying agent24 September 2014 | British Journal of Nursing, Vol. 23, No. Sup17Addressing common stoma complications16 August 2013 | Nursing and Residential Care, Vol. 15, No. 3 1 August 2012Volume 14Issue 8ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 16 August 2013 Published in print 1 August 2012 Information© MA Healthcare LimitedPDF download

Postoperative ileus in GI surgical patients: pathogenesis and interventions

Postoperative ileus is a common complication following surgery that causes signifcant discomfort and pain to the patient, while increasing hospital costs and length of stay. The development of postoperative ileus is multifactorial, infuenced by the autonomic nervous system, enteric nervous system, hormones and neuropeptides, infammation, anaesthesia, and narcotics. The multitude of factors involved in postoperative ileus necessitates a holistic approach to care. A combination of pharmacological agents, surgical techniques and postoperative nursing care can quicken the return of normal gastrointestinal motility. In this article, Caroline Lafon and Dr Lauren Lawson discuss the clinical course, the traditional treatment approaches, and current evidence-based research in the care of postoperative ileus.