Nursing the Gastrointestinal Surgical Patient
Gastrointestinal surgery is a broad term that encompasses various procedures performed on the digestive tract, such as gastrectomy, colectomy, appendectomy, cholecystectomy, and bariatric surgery. These surgeries can have significant impacts on the patients’ nutritional status, fluid and electrolyte balance, wound healing, and quality of life. Therefore, nurses play a vital role in providing comprehensive and holistic care to the gastrointestinal surgical patients, from preoperative assessment to postoperative recovery and discharge.
Preoperative Care
The preoperative care of the gastrointestinal surgical patient involves preparing the patient physically and psychologically for the surgery. The nurse should obtain a thorough medical history, including any previous surgeries, comorbidities, allergies, medications, and family history of gastrointestinal diseases. The nurse should also assess the patient’s nutritional status, bowel habits, hydration level, and pain level. Based on the type of surgery, the nurse should educate the patient about the procedure, the expected outcomes, the potential complications, and the postoperative care. The nurse should also provide emotional support and address any fears or concerns that the patient may have.
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The nurse should also perform some interventions to optimize the patient’s condition before the surgery. These may include administering bowel preparation agents, such as laxatives or enemas, to clear the bowel and reduce the risk of infection. The nurse should also ensure that the patient is adequately hydrated and has received prophylactic antibiotics if indicated. The nurse should also verify that the patient has followed the instructions regarding fasting and medication use before the surgery.
Postoperative Care
The postoperative care of the gastrointestinal surgical patient aims to promote wound healing, prevent complications, and restore normal bowel function. The nurse should monitor the patient’s vital signs, fluid and electrolyte balance, pain level, wound condition, and bowel sounds. The nurse should also assess for any signs of bleeding, infection, anastomotic leakage, ileus, or bowel obstruction. The nurse should also administer analgesics, antibiotics, antiemetics, and other medications as prescribed.
The nurse should also provide supportive care to the patient, such as encouraging early mobilization, deep breathing exercises, coughing and splinting, and incentive spirometry to prevent atelectasis and pneumonia. The nurse should also assist the patient with wound care and drainage management. The nurse should also educate the patient about dietary modifications, such as introducing clear liquids and advancing to solid foods gradually as tolerated. The nurse should also instruct the patient about wound care, medication use, activity restrictions, and follow-up appointments at home.
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Conclusion
Nursing the gastrointestinal surgical patient requires a comprehensive and holistic approach that addresses the physical and psychological needs of the patient throughout the perioperative period. The nurse should provide education, support, monitoring, and interventions to optimize the patient’s outcomes and quality of life.
References
– Burch J. (2016). Preoperative nursing care for patients undergoing gastrointestinal surgery. Nursing Standard (2014+), 31(9), 53-63.
– Coughlin S., & Richardson L. (2017). Postoperative nursing care for patients undergoing colorectal surgery. Nursing Standard (2014+), 32(5), 41-51.
– Dabirian A., Yaghmaei F., Rassouli M., & Tafreshi M.Z. (2010). Quality of life in ostomy patients: a qualitative study. Patient Preference and Adherence, 4(1), 11-16.
– DeSantis S.M., & Gonzalez A.D. (2018). Postoperative nursing care of gastric bypass patients. Nursing2019 Critical Care (Lippincott Williams & Wilkins), 13(6), 18-24.
– Kehlet H., & Wilmore D.W. (2008). Evidence-based surgical care and the evolution of fast-track surgery. Annals of Surgery (Lippincott Williams & Wilkins), 248(2), 189-198.
– Wexner S.D., & Fleshman J.W. (2007). Enhanced recovery after surgery: a new standard of care for gastrointestinal surgery? Diseases of The Colon & Rectum (Lippincott Williams & Wilkins), 50(5), 569-570.