WESLEYAN UNIVERSITY- PHILIPPINES CABANATUAN CITY COLLEGE OF NURSING

SUBMITTED BY:
Hannah Ivy P. Mari BSN IV-6

SUBMITTED TO:
Sir Erwin James V. Licup, R.N

a padded foot board should be used to prevent the patient from slipping down toward the end of the table. hyperextending the neck.  The procedure is usually performed to treat various disease of the thyroid gland that may not be treated effectively by chemotherapy or medication. If table is placed in reverse Trendelenberg position. Pack/ Drapes  Laparotomy pack with small fenestrated sheet  Rolled sheet/ towels Instrumentation  Major Lap tray  Thyroid tray  Lahey clamps  Spring retractor Supplies/ Equipment  Basin set  Suction  Blades  Needle counter issector sponge   Small drain  Solutions  Sutures   .  A total thyroidectomy is indicated for certain carcinomas and to relieve tracheal or esophageal compression.THYROIDECTOMY Definition  Removal of all or a portion of the thyroid gland. Position  Supine with rolled towel or sandbag between the scapulae.

Perioperative Nursing Consideration 1. 3. 3. The gland is then mobilized. An emergency tracheostomy tray will accompany the patient to the postanesthesia care unit and later to the patient·s room until breathing is unlabored and the chance of airway obstruction secondary to edema has passed. 4. The dressing is usually secured by a thyroid collar using a towel folded in thirds lengthwise. The towel is placed around the neck and crisscrossed in front. The strap muscles are separated or divided. The surgeon may request a fine silk suture to use to mark the incision line. The scrub person should maintain the sterility of the back table/ Mayo until the patient is extubated and breathing is stabilized.Procedure Overview 1. 2. 5. and all or part is removed depending on the involved pathology. . then fastened with tape. 2. 4. 6. The incision is made above the sternal notch. The platysma muscle is incised and retracted. and the wound is irrigated with warm saline. A drain may be inserted. Hemostasis is obtained. and the incision is closed in layers by an interrupted method. and blunt and sharp dissections are employed until the thyroid is exposed.

R. Garcia BSN IV-6 SUBMITTED TO: Sir Erwin James V.WESLEYAN UNIVERSITY.N .PHILIPPINES CABANATUAN CITY COLLEGE OF NURSING SUBMITTED BY: Arlene P. Licup.

caused by a musculofascila defect in the abdominal wall or groin area. compromising the viability of trapped tissues and thus necessitating their resection in addition to the herniography. It may or may not contain abdominal viscera.Incision Site Groin area. Packs/Drapes  Laparotomy pack or minor pack  Four folded towels V.  IV.HERNIORRHAPHY I. causing the peritoneum to bulge through the fascia in the groin area. Instrumentation  Basic tray or minor tray  Self retraining retractor . causing the peritoneum to bulge along the spermatic cord. Hernias are either reducible or irreducible that is incarcerated. direct or indirect. two types of herniation commonly occur. 2. with arms extended on armboards III. Definition  Repair of a herniation (protrusion) of the abdominal contents.   II. right or left oblique. The contents of an incarcerated hernia may become strangulated.  In the inguinal/ femoral regions. and is referred to as an incision hernia.Position  Supine.)Indirect Hernia: Caused by a congenital defect in the internal abdominal ring. The peritoneal bulge (sac) may contain abdominal viscera.) Direct hernia: Usually resulting from stress. 1. A hernia can occur within an old scar that is usually located in the abdominal (ventral) region.

2. several small hemostats are placed on the edge of the incised fascia. 3. . 3. After incising the fascia that lies over the spermatic cord (male). The pensrose drain should be moistened with saline before use. Synthetic Mesh is often used to repair recurrent hernias or large ventral hernias. Procedure 1. A specimen will be collected only during an indirect herniorrhaphy. 5. If indirect. If direct.VI. water  Synthetic mesh  Skin closure strips VII.Supplies/ Equipment  Basin set  Suction  Needle counter  Penrose drain  Dissector sponges  Sutures  Solutions ± saline. Perioperative Nursing Considerations 1. 4. the surgeon will dissect the sac away from the cord using Metzenbaum scissors. Both blunt and sharp dissections are used to gain access to the hernia. The surgeon begins the procedure by incising the groin. the sac is opened and the edges grasped with hemostasis. the surgeon will begin the suture the defect using interrupted suture of varying materials 6. VIII. The incision is deepened using the Metzenbaum scissors and cautery is used to control small bleeders. the sac may be lighted in place. 2. 7. The contents of the sac are pushed toward the abdomen and if small.

WESLEYAN UNIVERSITY.PHILIPPINES CABANATUAN CITY COLLEGE OF NURSING SUBMITTED BY: Hannah Ivy P.N . R. Mari BSN IV-6 SUBMITTED TO: Ma·am Merlyn Navallo.

This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque.pain. if left untreated for a sufficient period of time.ischemia and triggering of autonomic nervous system responses that exacerbate the imbalance between myocardial oxygen supply and demand.I. can cause damage or death (infarction) of heart muscle tissue (myocardium). DEFINITION Myocardial infarction (MI) or acute myocardial infarction (AMI).myocardial death. which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery. II. is the interruption of blood supply to part of the heart.depressed cardiac function. CAD Coronary vasospasms Coronary occlusion by embolus and thrombus Conditions decreasing perfusion such as hemorrhage and shock Hypertension Diabetes Mellitus PREDISPOSING FACTOR/ PRECIPITATING FACTOR        Hypercholosterolemia Smoking Hypertension Obesity Stress Sedentary Lifestyle Atherosclerotic coronary artery disease IV. ETIOLOGY       III. causing heart cells to die. PATHOPHYSIOLOGY  Interrupted coronary blood flow myocardial ischemia anaerobic myocardial metabolism for several hours. . The resulting ischemia (restriction in blood supply) and oxygen shortage.persistent ischemia.imbalance of myocardial oxygen demand and supply. commonly known as a heart attack.further triggering of autonomic nervous response.

LABORATORY / DIAGNOSTIC PROCEDURES y y y y ECG MYOCARDIAL ENZYMES BLOOD TESTS Test after the Acute Stage VI. Or your doctor may suggest that you have this procedure after your heart has had time to recover from your heart attack. SURGICAL MANAGEMENT  Coronary artery bypass surgery. This restores blood flow to the heart. MANAGEMENT A. C. NURSING MANAGEMENT Monitor and improve cleint s cardiopulmonary state Minimize the client anxiety Minimize metabolic demands Provide oxygen at 2 L/min (or as ordered) to relieve dyspnea and to prevent arrhythmias  Advise bed rest in semi-Fowler s position  Provide other dependent nursing interventions  Provide client health teaching     . MEDICAL MANAGEMENT M-Morphine O-Oxygen N-Nitriglycerin A-Aspirin B.V. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section).

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