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A laparotomy is a large incision made into the abdomen.

Exploratory laparotomy is used to visualize and examine

the structures inside of the abdominal cavity.
Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine
the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who
has sustained an injury to the abdomen.

Hysterectomy is the surgical removal of the uterus. In a total hysterectomy, the uterus and cervix are removed.

frozen section
a thin slice of tissue cut from a frozen specimen, often used for rapid microscopic diagnosis.

Peritoneal fluid: A procedure called a paracentesis is done to collect a sample of peritoneal fluid for testing.

Cystectomy is the medical term for removal of the bladder. Cystectomy is sometimes referred to as a radical
cystectomy, anterior pelvic clearance or a cystourethrectomy.

There are many causes for growths on the ovary. Your age and medical history are important in evaluating an
ovarian growth.

Prior to menopause, the ovary forms a fluid filled sac (ovarian cyst) every month as a normal part of the process of releasing
an egg. There are other reasons the ovary can form a cyst; most of these are not worrisome. If a cyst is large (over 5
centimeters), or doesn't go away after a few months, then you may need to have it further evaluated or removed. See ovarian

All ovarian growths that are not simple fluid filled sacs -- they are complex or solid -- should be investigated by your doctor
regardless of age.

Typically, ovarian cysts are functional (not disease related) and disappear on their own. During the days preceding
ovulation, a follicle grows. At the time of expected ovulation, the follicle fails to rupture and release an egg.

Instead of being reabsorbed, the fluid within the follicle persists and forms a cyst. Functional cysts usually disappear within
60 days without treatment and are relatively common. They occur most often during childbearing years (puberty to
menopause), but may occur at any time. No known risk factors have been identified.

Functional ovarian cysts are not to be confused with other disease conditions involving ovarian cysts, specifically benign
cysts of different types that must be treated to resolve, true ovarian tumors (including ovarian cancer), or hormonal
conditions such as polycystic ovarian disease.

Women have two ovaries, one on either side of the uterus. The ovaries — each about the size of an almond — produce eggs
(ova) as well as the female sex hormones estrogen and progesterone. An ovarian tumor is a growth of abnormal cells that
may be either noncancerous (benign) or cancerous (malignant). Although benign tumors are made up of abnormal cells,
these cells don't spread to other body tissues (metastasize). Ovarian cancer cells metastasize in one of two ways. Generally,
they spread directly to adjacent tissue or organs in the pelvis and abdomen. They can also spread through your bloodstream
or lymph channels to other parts of your body.

Three basic types of ovarian tumors exist, designated by where they form in the ovary. They include:

Epithelial tumors. About 85 to 90 percent of ovarian cancers develop in the epithelium, the thin layer of tissue that covers
the ovaries, according to the American Cancer Society.
Germ cell tumors. These tumors occur in the egg-producing cells of the ovary and generally occur in younger women.
Stromal tumors. These tumors develop in the estrogen- and progesterone-producing tissue that holds the ovary together.
The exact cause of ovarian cancer remains unknown. Some researchers believe it has to do with the tissue-repair process
that follows the monthly release of an egg through a tiny tear in an ovarian follicle (ovulation) during a woman's
reproductive years. The formation and division of new cells at the rupture site may set up a situation in which genetic errors
occur. Others propose that the increased hormone levels before and during ovulation may stimulate the growth of abnormal

Certain factors may increase your risk of ovarian cancer. Having one or more of these risk factors doesn't mean that
you're sure to develop ovarian cancer, but your risk may be higher than that of the average woman. These risk factors

Inherited gene mutations. While the vast majority of women who develop ovarian cancer don't have an inherited gene
mutation, the most significant risk factor for ovarian cancer is having an inherited mutation in one of two genes called breast
cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple
cases of breast cancer, which is how they got their names, but people with these mutations also have a significantly
increased risk of ovarian cancer.

Women with the BRCA1 mutation have a 35 to 70 percent higher risk of ovarian cancer than do women without this
mutation, and for women with a BRCA2 mutation, the risk is between 10 and 30 percent higher. For most women, the
overall lifetime risk is about 1.5 percent, according to the ACS. You're at particularly high risk of carrying these types of
mutations if you're of Ashkenazi Jewish descent.

Another known genetic link involves an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC).
Women in HNPCC families are at increased risk of cancers of the uterine lining (endometrium), colon, ovary and stomach.
Risk of ovarian cancer associated with HNPCC is lower than is that of ovarian cancer associated with BRCA mutations.

Family history. Sometimes, ovarian cancer occurs in more than one family member but isn't the result of any known
inherited gene alteration. Having a family history of ovarian cancer increases your risk of the disease by 10 to 15 percent,
according to the ACS.
A history of breast cancer. If you've been diagnosed with breast cancer, your risk of ovarian cancer also is elevated.
Age. Ovarian cancer most often develops after menopause. Your risk of ovarian cancer increases with age through your late
70s. Although most cases of ovarian cancer are diagnosed in postmenopausal women, the disease also occurs in
premenopausal women.
Childbearing status. Women who have had at least one pregnancy appear to have a lower risk of developing ovarian
cancer. Similarly, the use of oral contraceptives appears to offer some protection against ovarian cancer.
Infertility. If you've had trouble conceiving, you may be at increased risk. Although the link is poorly understood, studies
indicate that infertility increases the risk of ovarian cancer, even without use of fertility drugs. Some research has also
suggested that taking fertility drugs, such as clomiphene (Clomid), for more than one year may increase your risk of ovarian
cancer, but it's not clear whether the increased risk actually comes from the drug or from the infertility.
Hormone replacement therapy (HRT). Findings about the possible link between postmenopausal use of the hormones
estrogen and progestin and risk of ovarian cancer have been inconsistent. However, a recent analysis of numerous studies,
published in the journal Gynecologic Oncology, confirmed an association between HRT and ovarian cancer, particularly for
those who took estrogen only. The risk appears to be highest among women who took HRT for more than five years.
Obesity. Women who are obese have a greater risk of ovarian cancer. Obesity may also be linked to more-aggressive
ovarian cancers, which can result in a shorter time to disease relapse and a decrease in the overall survival rate.
Male hormones. The medication danazol, a male hormone (androgen), is used to treat endometriosis and has been linked to
an increased risk of ovarian cancer. More study is needed to further define this association.

Symptoms of ovarian cancer are nonspecific and mimic those of many other more common conditions, including digestive
and bladder disorders. A woman with ovarian cancer may be diagnosed with another condition before finally learning she
has cancer. Common misdiagnoses include irritable bowel syndrome, stress and depression.

The key seems to be persistent or worsening signs and symptoms. With most digestive disorders, symptoms tend to come
and go, or they occur in certain situations or after eating certain foods. With ovarian cancer, there's typically little
fluctuation — symptoms are constant and gradually worsen.

Recent studies have shown that women with ovarian cancer are more likely than are other women to consistently experience
the following symptoms:
Abdominal pressure, fullness, swelling or bloating
Urinary urgency
Pelvic discomfort or pain
Additional signs and symptoms that women with ovarian cancer may experience include:

Persistent indigestion, gas or nausea

Unexplained changes in bowel habits, such as constipation
Changes in bladder habits, including a frequent need to urinate
Loss of appetite or quickly feeling full
Increased abdominal girth or clothes fitting tighter around your waist
Pain during intercourse (dyspareunia)
A persistent lack of energy
Low back pain
Changes in menstruation

Preoperative Phase
Preadmission Testing Functional alignment
1. Initiates initial preoperative assessment •
2. Initiates teaching appropriate to patient’s needs Exposure of surgical site
3. Involves family in interview 5. Applies grounding device to patient
4. Veries completion of preoperative testing 6. Ensures that the sponge, needle, and instrument counts are
5. Veries understanding of surgeon-specic preoperative correct
orders 7. Completes intraoperative documentation
(eg, bowel preparation, preoperative shower) Physiologic Monitoring
6. Assesses patient’s need for postoperative transportation 1. Calculates effects on patient of excessive uid loss or gain
and care 2. Distinguishes normal from abnormal cardiopulmonary data
Admission to Surgical Center or Unit 3. Reports changes in patient’s vital signs
1. Completes preoperative assessment 4. Institutes measures to promote normothermia
2. Assesses for risks for postoperative complications Chart18-1Chart18-1
3. Reports unexpected ndings or any deviations from normal Psychological Support (Before Induction and When Patient
4. Veries that operative consent has been signed Is Conscious)
5. Coordinates patient teaching with other nursing staff 1. Provides emotional support to patient
6. Reinforces previous teaching 2. Stands near or touches patient during procedures and
7. Explains phases in perioperative period and expectations induction
8. Answers patient’s and family’s questions 3. Continues to assess patient’s emotional status
9. Develops a plan of care
In the Holding Area
1. Assesses patient’s status; baseline pain and nutritional
2. Reviews chart
3. Identies patient
4. Veries surgical site and marks site per institutional policy
5. Establishes intravenous line Postoperative Phase
6. Administers medications if prescribed Transfer of Patient to Postanesthesia Care Unit
7. Takes measures to ensure patient’s comfort 1. Communicates intraoperative information
8. Provides psychological support •
9. Communicates patient’s emotional status to other Identies patient by name
appropriate •
members of the health care team States type of surgery performed

Intraoperative Phase Identies type of anesthetic used
Maintenance of Safety •
1. Maintains aseptic, controlled environment Reports patient’s response to surgical procedure and
2. Effectively manages human resources, equipment, and anesthesia
supplies •
for individualized patient care Describes intraoperative factors (eg, insertion of drains or
3. Transfers patient to operating room bed or table catheters; administration of blood, analgesic agents, or other
4. Positions the patient medications during surgery; occurrence of unexpected events)
• •
Describes physical limitations see Chap. 20)

Reports patient’s preoperative level of consciousness Surgical Unit
• 1. Continues close monitoring of patient’s physical and
Communicates necessary equipment needs psychologi-
• cal response to surgical intervention
Communicates presence of family and/or signicant others 2. Assesses patient’s pain level and administers appropriate
Postoperative Assessment Recovery Area relief measures
1. Determines patient’s immediate response to surgical 3. Provides teaching to patient during immediate recovery
intervention period
2. Monitors patient’s physiologic status 4. Assists patient in recovery and preparation for discharge
3. Assesses patient’s pain level and administers appropriate home
pain relief 5. Determines patient’s psychological status
4. Maintains patient’s safety (airway, circulation, prevention 6. Assists with discharge planning
of Home or Clinic
injury) 1. Provides follow-up care during ofce or clinic visit or by
5. Administers medications, uid, and blood component tele-
therapy, if phone contact
prescribed 2. Reinforces previous teaching and answers patient’s and
6. Provides oral uids if prescribed for ambulatory surgery family’s
patient questions about surgery and follow-up care
7. Assesses patient’s readiness for transfer to in-hospital unit 3. Assesses patient’s response to surgery and anesthesia and
or for their
discharge home based on institutional policy (eg, Alderete effects on body image and function
score, 4. Determines family’s perception of surgery and its outcome