Group 2 Lower Abdominal

Suhainiza binti Dahalan

Azanwati binti Hassan resection
Gracie anak kadoi
Senorita anak Limping for diverticulitis
Learning outcomes
1. Define the diverticular disease
2. Explain the Etiology of diverticular disease
3. Explain the clinical manisfestation
4. Explain the preparation of specific
instruments.
5. Describe the role in assissting Lower
Abdominal
resection
6. Describe nursing diagnosis & intervention
 Large intestinal colon

transverse Discending

Ascending
Diverticular Diseases
Definition
• a group of conditions that affect the large
intestine (colon).
• It involves small pouches or sacs, called
diverticular.
• These pouches can form in the intestine
wall and cause problems. The most
common conditions of diverticular disease
are:
Diverticular Diseases

Diverticulosis:
• The presence of diverticular
without associated complications
or problems which can lead to
more serious issues including
diverticulitis, perforation ,
stricture , fistulas, and bleeding.
Diverticular Diseases

Diverticulitis:
• Diverticular become inflamed.
Complications of diverticulitis
can include repeated infections
and development of perforations
in the colon wall.
Diverticular disease
Diverticular disease
Diverticular Diseases

Etiology
There is no one specific cause, but
possible ones include:
 Obesity
 Low fiber diet
 Lack of exercise
 Age
 Hereditary
Diverticular Diseases

Clinical Manifestation
 Diverticulitis, infection and
inflammation of diverticula, can occur
suddenly and without warning.
Diverticular Diseases

 Symptoms of diverticulitis may include:

 Diarrhea and/or constipation
 Painful cramps or tenderness in the
lower abdomen (mild to severe pain in
the left lower quadrant)
 Chills or fever
 Flatulence
 Bloating / abdominal distention.
 Nausea /Vomiting
Preparation of specific instruments

a. Sterile instrument trolley( video)

b. Mayo trolley ( video)
Preparation of specific instruments
List instrument
• Basic general set
• GIT set
Preparation of specific instruments
Consumables
• blade 10 x2
• Active electrode with diathermy
tip extention.
• Sterile sponges and laparotomy
pads.
Preparation of specific instruments

• sutures and ties,

• Suturing device and sleeve, e.g.,
Endoloop
• Multifire ligating clip applier
• Disposable automatic stapler-
cutter of choice.
Preparation of specific instruments

• self-retaining retractor
• Fiberoptic retractor to facilitate
visualization of the pelvic
structures
Preparation of specific instruments

• Abdominal drain
21 fr /27 fr
• Skin stapler.
• Ostomy wafer and bag.
– 1 piece type
Preparation of specific instruments

For Low Anterior Resection

• Disposable stapler,
– e.g., EEA or ILS with sizers
• Contour
• Linear cutter
Preparation of specific instruments

Equipment
• ESU
• Harmonic ultrasonic scaple
• Suction apparatus
 Consumables

Linear
Contour cutter
 Specific instruments

A B

Non-crushing
Crushing
Lower Anterior Resection Of The Sigm
oid Colon With End-to-end
Rectosigmoigostomy
Operative procedure
 Colostomy
Intoduction
• Created as to reestablishing continuity of the
GI tract after colon resection such as
• Lower anterior resection for diverticulitis

2424
 Cont...
Definition
bringing the proximal end of the divided
colon (or a loop of colon) through the
anterior abdominal wall and suturing it to the
skin to divert the fecal stream.
( Rothrock.J.C 2017)
 cont...
Two categories

Temporary Permenant
• Known as fecal • needed after colon
diversion resection when the
• may be necessary to remaining colon is of
allow to allow a distal insufficient length to
anastomosis to heal. allow safe
reconnection
 Colostomy operative procedure

End
colostomy
procedure
 End colostomy procedure
A) Core of subcutaneous tissue is removed after making
a circular skin incision with a #10 blade and using an
electrosurgical pencil to dissect down to the anterior
fascia.
B) Muscle fibers are split.
C) Tissues are dissected to the posterior layers, and
 End colostomy procedure
D) The peritoneum is opened.
E) Colon is delivered through the abdominal
wall so that it extends 2 to 3 cm beyond the skin
surface.
F) Bowel is tacked internally to the peritoneal
defect.
 End colostomy procedure
G) Four sutures are placed in each quadrant,
incorporating the full-thickness cut end of the colon,
the serosal surface approximately 1 to 2 cm below
the open end of the colon, and up to the dermis.
Additional sutures are used to mature the
stoma, which refers to everting the mucosa to create
a stable opening through which feces can evacuate.
 Nursing consideration
Bowel septic technique Practise
Rationale
• Instruments, suture, and equipment used during the
open gastrointestinal tract contain peritoneal
microorganisms that can lead to surgical site infections.
• Isolation of instruments and supplies used during bowel
anastomosis can reduce the chance of a post operative
infection
 Cont...
• Needed for the Bowel Isolation Technique
should be placed in a large basin
• 3 phases to be considered.
• Changing glove/gown
 Cont...
Before opening bowel
• Drape towels around surgical site and any
place where there is potential exposure to open
bowel contents.
• Clear off mayo stand and drape with additional
towels before adding items for the anastomosis.
 Cont...
During Anastomosis
• Have a large basin available for grossly contaminated
instrument, stapler and specimen.
• Do not return contaminated instruments or supplies to
the back table.
• If additional instruments are needed, use a sponge
stick to retrieve clean instruments from the back table
 Cont...
Once bowel is closed and anastomosis is
complete
• Return all instruments and supplies, (sponges,
suction tip, staplers and towels) that were used
during the anastomosis, back into the basin.
• Close isolation needle counter and place
inside of basin.
 Cont...
After wound irrigation
 Entire surgical team-fresh glove & gown
 Setup of clean instrument-closure
 Reinforcement drape
 Extra instrument -Pre-op planning-Instiutional
protocal ( AORN 2016)
NURSING CARE PLAN

• Nursing Diagnosis : Disturbed

Body Image related to intestinal
diversion with evidence by
present colostomy.
• Outcome : The patient will
demonstrate acceptance of
expected changes in appearance
and self-care
 Nursing Interventions
NURSING INTERVENTION RATIONALE
• Encourage verbalization of  To promotes ventilation of
feelings about anticipated feelings and allows for more
alterations in body function if helpful responses to patient.
diversion procedure planned.

• Elicit the patient’s and  To provides ongoing support

family’s perceptions of for patient and family
planned surgical intervention.
 Cont…
NURSING INTERVENTION RATIONALE

• Identify effective sources To encourage the patient

of support develop more positive
responses to the changes
in his or her body.

• Encourage patient to  To improve self-

implement confidence and
cultural,religious,ethnic or acceptance of the
social customs associated situation.
 Cont….
NURSING INTERVENTION RATIONALE

• Provide accurate  To enhances trust and

information relevant to rapport between patient
patient’s postoperative and nurse and to give
expectations patient prepare mental
and physical.
• Provide thorough teaching  To help patient
and complete aftercare achieve self-care.
instructions for the patient.
 Cont…
NURSING INTERVENTION RATIONALE

• Refer patient to  To manage and

Wound,Ostomy and improving quality of
Continence Nurses care of these patients
(WOCN) if this has not
already been done
Conclusion
As a peri-operative nurses and
scrub personnel must be familiar
with the fundamental of
gastroinstestinal surgery and
common patient care either the
surgery will be done open or
laparoscopically.
 References
• AST( 2017) AST Guidelines for Best Practices in Bowel Technique. Available
at
https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standar
d_Bowel_Technique.pdf retrieved on 18.3.2020 @ 0930hrs
• Goldman.M.A, ( 2020) F.A Davis , Pocket guide to the operating room 4th
Edi. USA
• Phillip.N ( 2017) Berry & Kohn's, Operating Room Technique 13th
Edi.Elsevier.
• Rothrock.J.C( 2019) Alexender's Care of the patient in surgery 16th
Edt.Elsevier.