Validação de um protocolo de teleconsulta pré-operatória de enfermagem em hernioplastia e colecistectomia / Validation of a preoperative nursing teleconsultation protocol for hernioplasty and cholecystectomy

Objetivo: Validar um protocolo de teleconsulta pré-operatória de enfermagem em hernioplastia e colecistectomia. Método: Estudo metodológico realizado em um hospital filantrópico localizado em Rio Branco, Acre. Participaram dez enfermeiros especialistas em assistência perioperatória. A validação ocorreu no período de agosto a outubro de 2021. O protocolo do estudo foi fundamentado na revisão de escopo do Instituto Joanna Briggs (JBI) e nos diagnósticos e nas intervenções de enfermagem de ansiedade e o risco de recuperação cirúrgica retardada. Os dados foram analisados pelo índice de validade de conteúdo, adotando o valor maior ou igual a 0,8 na análise global. Resultados: Os enfermeiros validaram o conteúdo proposto, atestando sua abrangência, clareza e relevância em todos os itens, com altos índices de validade de conteúdo globais maiores que 0,95. Conclusão: O protocolo construído foi validado por especialistas, sendo evidenciadas sua abrangência, clareza e relevância de sua tecnologia didática instrucional para aplicabilidade clínica no período pré-operatório

Objective: To validate a preoperative nursing teleconsultation protocol for hernioplasty and cholecystectomy. Method: This is a methodological study carried out at a philanthropic hospital located in the city of Rio Branco, state of Acre, Brazil. Ten nurses specialized in perioperative care participated in the study. The validation took place from August to October 2021. The study protocol was based on the scoping review by the Joanna Briggs Institute ( JBI) and on nursing diagnoses and interventions for anxiety and the risk of delayed surgical recovery. Data were analyzed using the content validity index, adopting a value greater than or equal to 0.8 in the overall analysis. Results: The nurses validated the proposed content, attesting to its comprehensive-ness, clarity, and relevance in all items, with high overall content validity indices greater than 0.95. Conclusions: The developed protocol was validated by experts, showing the comprehensiveness, clarity, and relevance of its instructional didactic technology for clinical applicability in the preoperative period

"Captain of the ship" doctrine continues to take on water.

The captain of the ship doctrine, which has been interpreted to mean that the surgeon's mere presence in the OR subjects him or her to legal liability for everyone's negligence in that room (akin to the responsibility of the captain of a ship who is held responsible for everything that happens on that ship), emerged in 1949 and grew in popularity through the 1950s. The major reason for this doctrine's popularity was that injured patients were precluded from suing hospitals under the then applicable charitable immunity doctrine. Charitable immunity declined in the 1960s, and by the 1970s, so too was the captain of the ship doctrine in decline. Pennsylvania, which first used the picturesque phrase in 1949, rejected the doctrine in 1974. In the meantime, it has come under much criticism, even among states that adopted it. Despite this decline and despite court language that sometimes borders on ridicule (e.g., anachronistic, prostrate doctrine, indiscriminate repetition), the felicity of the phrase has kept it alive in some states and in many ORs, even in states that have expressly rejected the doctrine. Even more than 20 years after its first rejection, however, courts still are being asked to adopt the doctrine. In 2001, the Wisconsin Supreme Court declined to adopt the doctrine, adding to the litany of states that have taken an express position against it.

Pre- and postoperative information needs.

The purpose of this study was to investigate patients' need for pre- and postoperative information. Fifty patients admitted to open cholecystectomy were included in the study, 37 women and 13 men. Their median age was 49.5 years, ranging 17-76. The patients answered one questionnaire both at admission and at discharge. In the questionnaire, 48 statements had to be answered on a five-point, Likert scale. Our data show that patients admitted for cholecystectomy want a lot of information both at admission and at discharge. The most requested information was related to anxiety-creating factors such as pain and post-operative symptoms after surgery. Thirty per cent of the patients wanted both written and verbal information. This result focuses on the need to develop and share with the patient both written and verbal information.

Concordancia entre los hallazgos ultrasonográficos y hallazgos operatorios en colecistectomías laparascópicas en el Hospital Nacional "Carlos Alberto Seguín Escobedo" IPSS de marzo de 1994 a diciembre de 1995

En el presente trabajo realizado en el Hospital Nacional "Carlos Alberto Seguín Escobedo" se ha establecido la concordancia y/o diferencia entre los hallazgos ultrasonográficos y hallazgos operatorios en colecistectomias laparoscópicas. Para ello se analizaron 253 historias clínicas de pacientes a quienes se les realizó colecistectomía laparoscopica previo estudio ultrasonográfico de hipocondrio derecho. Un 77.47 por ciento de los pacientes fueron de sexo femenino y 22.53 por ciento de sexo masculino. La media de edad fue de 42.9 años. La sintomatología mas frecuente fue: dolor en hipocondrio derecho y dispepsia a grasas (71.15 y 56.92 por ciento). Se ha encontrado que existe concordancia entre el hallazgo ecográfico y hallazgo operatorio vía colecistectomia laparoscópica en: la morfología vesicular, presencia y número de cálculos en la vesícula, dilatación del colédoco, presencia de arenilla, pólopos y morfología hepática. Se ha observado diferencia estadísticamente significativa entre el tamaño vesicular (largo y ancho), grosor de las paredes vesiculares y el tamaño de los cálculos entre ambos diagnósticos anteriormente mencionados. Por consiguiente, el estudio ultrasonográfico es beneficioso en un 63.63 por ciento como examen preoperatorio para una posterior colecistectomía laparoscópica.

Impact of patient-controlled analgesia on required nursing time and duration of postoperative recovery.

BACKGROUND AND OBJECTIVES: Patient-controlled analgesia (PCA) offers effective postoperative pain management. However, the evidence of economic benefits associated with its use is lacking. Although suggestive, the potential economic advantages of PCA in saving nursing time and shortening hospital stay need objective documentation. METHODS: This study compared the effects of morphine administered by PCA systems with intramuscular (i.m.) morphine injection on patient analgesic response, satisfaction, nursing time requirements, and postoperative recovery in 23 patients undergoing "open" cholecystectomy and 44 patients undergoing lumbar laminectomy and bony fusion. After the operation, patients in the PCA group received 1.5-2 mg morphine with a lockout of 5-10 minutes on demand, whereas those in the i.m. group received 0.15-0.2 mg/kg every 4 hours on demand. Visual analog scale (VAS) pain scores and satisfaction scores were evaluated at 4-hour intervals while nursing time spent on both analgesia-related and non-analgesia-related activities was recorded continuously by a team of independent observers on the ward. Recovery time profile for the return of bowel function, activities of daily living, ambulation without support, and length of hospital stay was also recorded. RESULTS: It was found that morphine consumption, VAS, and satisfaction scores were similar in both PCA and i.m. treatment groups following both types of surgery. However, the delay in nurse response to i.m. morphine request ranged from 27.2 +/- to 42.1 +/- 11.8 minutes. The demand of nursing time on analgesia administration was less with PCA. The magnitude of time saving was 10 min/patient/d in cholecystectomy patients and 13 min/patient/d in laminectomy patients. The speed of postoperative patient recovery was similar between the two analgesia groups. Length of hospital stay following cholecystectomy was shorter--92.0 +/- 5.9 hours with PCA versus 128.6 +/- 22.2 hours with i.m. (not statistically significant)--whereas that following laminectomy was not different. CONCLUSIONS: Data in this study have demonstrated some beneficial effects of PCA on nursing time requirements when it was used following cholecystectomy and lumbar laminectomy at the University of Toronto: however, the magnitude of these benefits was less than previously reported. The effects of PCA on postoperative recovery and hospital stay, however, were not significantly different from i.m. therapy.

Open cholecystectomy: a same-day surgical experience.

1. With only minor revisions in conventional cholecystectomy procedure, perioperative nurses can easily acquire the techniques and skills required for open ambulatory cholecystectomy. 2. Discharge for patients is determined through criteria that address level of consciousness, vital signs, activity, pain level, bleeding, and intake and output. Patients generally attain an acceptable score within a few hours of surgery. 3. There are several patient benefits of open cholecystectomy. A small incision in the fold of the abdomen results in an unnoticeable scar, and patients experience little or no pain. In addition, patients return home within 3 to 10 hours of surgery and return to work within 5 to 21 days.

Experiencia de enfermeria en pacientes colecistectomizados por vía laparoscópica / Nursing experience in cholecytectomized patients through laparoscopy

La colecistectomía laparoscópica es una nueva alternativa de tratamiento de la litiasis biliar sintomática que presenta algunas ventajas sobre la colecistectomía abierta. En esta comunicación se analiza la experiencia de enfermería en el manejo de los primeros 50 pacientes de colecistectomía laparoscópica realizada en el Servicio de Cirugía del Hospital San Juan de Dios. En los pacientes que no tuvieron complicaciones, la levantada y la realimentación fueron precoces (menos de 24 horas), por lo que la estada postoperatoria promedio fue sólo de 2,5 días. La atención de enfermería en el pre y postoperatorio de los pacientes intervenidos por vía laparoscópica no difieren mayormente de la atención que se le otorga a los pacientes operados por laparotomía

Laparoscopic cholecystectomy.

Judith presented with a long-standing history of right upper quadrant pain which was found to be the result of cholelithiasis. She was treated by means of a laparoscopic cholecystectomy and underwent an uneventful recovery apart from complaining of tiredness. This may have been due to chronic overstrain caused by trying to cope with the needs of her family and her two elderly parents. Her problems stemmed from uncertainty about the procedure and worry about how her husband would cope while she was recovering. Both problems were resolved by explanation and discussion, bringing in other family members to support her so that her feelings of guilt could be recognized and dealt with. To date, she continues to make a good recovery and is keen to resume her normal family role.

Laparoscopic cholecystectomy [continuing education credit].

1. Laparoscopic cholecystectomy is a relatively minor procedure compared with open cholecystectomy; the patient experiences less postoperative pain, and is able to ambulate quicker, and many risk factors are reduced. 2. Approximately 1% of laparoscopic cholecystectomies are converted to open procedures because of unusual anatomy, an inordinate amount of bleeding, or considerable adhesions. 3. The patient is prepared and draped in the usual manner for abdominal surgery; if an open procedure becomes necessary, redraping will not be needed. To prevent an unnecessary delay, the back table should include instrumentation for an open procedure.

Laser laparoscopic cholecystectomy in the ambulatory setting.

Gallbladder disease, with or without the formation of stones, can be treated in a number of ways. Conservative treatment of a low-fat diet may be difficult for the patient to maintain over a period of time, and may be ineffective in the long run. Chemodissolution of gallstones is a costly pharmacologic treatment that may require repeating within a 5-year period. Other forms of treatment include the still experimental shock wave lithotripsy to break up gallstones before chemodissolution therapy, or surgical removal of the gallbladder by traditional open laparotomy or by laparoscopic intervention. Laser laparoscopic cholecystectomy, a procedure suited to the ambulatory surgery setting, can be used for many individuals requiring cholecystectomy. It is less invasive than traditional surgery and results in a shorter hospital stay, less postoperative pain, and more rapid ambulation and recuperation. Most people can return to work in 3 days and can resume full physical activity after 1 week. Potential intraoperative complications include the puncture or rupture of a blood vessel or viscus with resulting hemorrhage or sepsis. Less serious complications in the postoperative time frame can include nausea and vomiting, minimal to moderate abdominal discomfort, and referred shoulder pain secondary to the pneumoperitoneum. A strong social support system is essential for the patient who is discharged to home within 4 to 23 hours after surgery.