Laparotomy is the surgical removal of the colon due to intestinal adhesions and usually occurs in the small intestine. (Arif Mansjoer, 2000)
Laparotomy surgery is a procedure to open the abdominal cavity for the purpose of exploration.
Laparotomy post treatment is a form of care given to patients who have undergone abdominal surgery.
Range of Laparotomy
1. Midline incision
2.±2.5 cm), length (12.5 cm). Paramedian, ie, slightly to the side of the center line (
3. Transverse upper abdominal incision, namely an incision at the top, such as surgery and splenektomy colesistotomy.
4. Transverse lower abdominal incision, namely the transverse incision 4 cm above the operations.±anterior iliac spine, eg under appendictomy
1. Abdominal trauma (blunt or sharp).
3. Bleeding in the gastrointestinal tract.
4. Blockage of the small intestine and colon.
5. The period of the abdomen (Tumor, cyste etc.).
C. NURSING MANAGEMENT
1. Reducing complications from surgery.
2. Accelerate healing.
3. Restoring the function of patients as much as possible before surgery.
4. Maintaining the patient's self concept.
5. Preparing the patient goes home.
Care after surgery
1. Postoperative nursing actions
a. Monitor consciousness, vital signs, CVP, intake and output
b. Observation and record drain darai properties (color, amount) drainage.
c. In organizing and moving the position of the patient must be careful not to drain uprooted.
d. Sterile wound care.
In the post-surgery patients are generally not allowed to swallow food after surgery. foods recommended in postoperative patients are foods high in protein and vitamin C. Protein is needed in the process of wound healing, whereas the antioxidant vitamin C helps increase body resistance to infection prevention.
diit restriction does is NPO (nothing peroral)
Usually new foods given if:
• Abdominal bloating not
• Peristaltic normal bowel
• Positive flatus
• Bowel positive movement
Usually the patient is positioned to lie in bed so that the situation is stable. Usually the initial position is supine, but must still be done in order to avoid changes decubitus position. Patients undergoing abdominal surgery are encouraged to perform early ambulation.
4. Meeting the needs of elimination
- Voluntary control urinary function after 6-8 hours post inhalation anesthesia, IV, spinal.
Anesthesia, IV infusion, surgery manipulationàretained urine.
- Prevention: Inspection, Palpation, Percussionàlower abdomen (bladder distension).
- Dower catheteràexamine the color, the amount of urine, urine output < 30 ml / houràrenal complications.
- Nausea vomiting canà40% of clients with GA during the first 24 hours lead to stress and irritation of GI injury and can improve ICT in head and neck surgery and IOP increases.
- Assess the gastro intestinal function by auscultation of bowel sounds.
- Kaji paralitic ileusàbowel sound (-), abdominal distension, no flatus.
- The amount, color, consistency stomach contents every 6-8 hours.
- Insertion of intra-operative NG tube to prevent postoperative complications with decompresi and gastric drainage.
• Increase the break.
• Provide an opportunity to cure the GI trac.
• Monitor bleeding.
• Preventing bowel obstruction.
• Irrigation or drug delivery.
1. Impaired tissue perfusion with respect to tromboplebitis.
Tromboplebitis postoperative usually occurs 7-14 days after surgery. Tromboplebitis great danger arises when the blood is separated from the walls of veins and join the bloodstream as emboli to the lungs, liver, and brain.
Prevention tromboplebitis the postoperative leg exercises, ambulatif early.
Wound infections often appear in 36-46 hours after surgery. The organisms that cause infections are most often stapilokokus aurens, organisms; gram positive. Stapilokokus resulted pernanahan.
To avoid wound infection is the most important wound care with attention to aseptic and antiseptic.
3. Damage to skin integrity in relation to wound dehiscence or eviserasi.
Wound dehiscence is an open wound edges.
Eviserasi injury is the release of internal organs through an incision.
Factors causing dehiscence or eviserasi are wound infection, surgical error closing time, a heavy strain on the abdominal wall as a result of coughing and vomiting.
The process of wound healing
• The first phase
Lasts up to 3 days. Trunk leucocytes much damaged / fragile. New blood cells develop into healing where nodes fibers are used as a framework.
• The second phase
From day 3 to day 14. Charging by collagen, the entire periphery of epithelial cells arising perfect in 1 week. The new network is growing strongly and redness.
• The third phase
Approximately 2 to 10 weeks. Collagen constantly dumped, new signage networks and muscles can be reused.
• The fourth phase
Last phase. Healing will shrink and shrink.
Efforts to accelerate wound healing
1. Increase intake of foods high in protein and vitamin C.
2. Avoid anti-inflammatory drugs such as steroids.
3. Prevention of infection.
4. Returns physical function.
Returns physical function immediately after surgery with breathing and coughing exercises effective, early mobilization exercises.
E. Evaluation Criteria
Expected results after postoperative patient care, include;
1. No there is pain during wound healing.
2. Normal incisional wounds without infection.
3. No complications arise.
4. Elimination pattern smoothly.
5. Patients remained in the optimal level without disabilities.
6. Losing weight or at least remain normal.
7. Before going home, patients know about:
• Advanced Medicine.
• The type of drugs given.
• Limit activity and plan activities at home.
a. Primary Survey
-Check the airway obstruction of foreign matter (solid, liquid) after the surgery due to administration of anesthesia.
- Potency airway, àput the hand over the mouth or nose.
- àkeadekwatan lung expansion, symmetry. Auscultasi lung
- compression on the brainstem will cause disturbances in heart rhythm, resulting in a change in breathing pattern, depth, frequency and rhythm, can be Cheyne Stokes breathing or ataxia. Breath sounds, stridor, ronkhi, wheezing (kemungkinana due to aspiration), there tends to be an increase in sputum production in the airway.
Changes in breathing (on average, pattern, and depth).- RR <à depressive disorder Narcotic, rapid respiration, shallow à10 X / cardiovasculair minutes or an average increase metabolism.
- Inspection: The movement of the chest wall, muscle use a respirator diaphragm, sternalàanathesi effects of excessive obstruction. retraction
The effect of increased intracranial pressure on blood pressure varies.- Pressure on the vasomotor center will improve the transmission of parasympathetic stimulation to the heart which would cause a slow pulse, a sign of increased intracranial pressure. Changes in heart rate (bradycardia, tachycardia interspersed with bradycardia, dysrhythmias).
-Inspection mucous membrane: color and moisture, skin turgor, bandage.
4) Disability: focus on neurological status
-Assess the patient's level of consciousness, signs of eye response, motor response, and vital signs.
- Inspection of response to stimuli, speech problems, difficulty swallowing, limb weakness or paralysis, visual changes, and restless.
-Assess the patient's surgical bandage the bleeding
b. Secondary Survey: Physical Examination
Patients appear tense, facial pain, weakness. Awareness compost mentis, GCS: 4-5-6, T 120/80 mmHg, N 98 x / min, S 374 0C, RR 20 X / min.
Inspection no ascites, liver palpation palpable two fingers below the ribs, and the spleen was not enlarged, faint percussion sounds, bowel sounds 14 X / min.
Abdominal distension and intestinal peristaltic assessment is to be done on the gastrointestinal tract.
Able to lift up the hands and feet. Upper limb muscle strength and lower limb 4-4 4-4., Akral cold and pale.
Skin wrinkles, pale. Turgor was
4) neurological examination
If severe bleeding / wide and the brain stem will be interference with cranial nerve, it can happen:
- Changes in mental status (orientation, alertness, attention, concentration, problem solving, the influence of emotional / behavioral and memory).
-Changes in vision, such as sharpness, diplopia, loss of some field of view, photo phobia.
-Pupillary changes (response to light, symmetry), deviation of the eyes.
-A decline in the power of hearing, balance the body.
-Often arise hiccup / hiccups due to the compression of the vagus causes spasmodic diaphragm compression.
hipoglosus nerve disorders.- Disorders that seemed tongue falling to one side, dysphagia, disatria, so hard to swallow.
c. Tersiery Survey
Clients appear weak, pale skin and kunjungtiva akral warm. Blood pressure 120/70 mm Hg, pulse 120x/menit, capillary refill of 2 seconds. Laboratory tests: HB = 9.9 g%, HCT and PLT = 32 = 235.
Clients conscious, GCS: 4-5-6 (total = 15), the client seems weak, reflexes within normal limits.
Client installed doewer chateter urine deposited 200 cc, tawny color.
G. Nursing Diagnosis
1. Disruption sense of comfort pain associated with the incision.
2. Damage to skin integrity related to the incision.
3. High risk of wound infection associated with poor hygiene.
4. Impaired tissue perfusion related to bleeding.
5. Lack of fluid volume associated with postoperative bleeding.
6. Ineffective breathing pattern related to the effects of anesthesia.
7. Ineffective airway clearance related to the buildup secret.
8. Changes in the pattern of urinary elimination related to the effects of anesthesia.
9. Changes in nutrition less than the needs associated with nausea and vomiting.
Brunner and Suddart. (1988). Textbook of Medical Surgical Nursing. Sixth Edition. J.B. Campany Lippincott, Philadelphia.
Doenges, Marilynn E. (2000). Nursing care plan. EGC, Jakarta.
And from a variety of sources.