Perioperative Nursing in Subtotal Gastrectomy With Billrothll : A case study

Abstract

Background: In patient with pylorus obstruction, gastrojejunostomy was undergone in order to reconstruct gastrojejunal connection. Major complication following the surgery is anastomosis which may result in mortality unless patient evaluation had not been performed. The major surgery is time-consumed and complicated procedure therefore the expert surgical nurse team is required. Objectives of nursing care are providing patient safety, no complication, improve quality of life and had ability to live their everyday life.
Objective: To provide patient evaluation, care plan and nursing care to patient with subtotal gastrectomy with Billroth II in which focus to patient safety and no complication in all three phase of the surgery
Method: A selective case was included during underwent the surgery. Patient data was retrospectively collected from patient’s chart and record.
Result: A male patient aged 68 years, married, weight 41 kilograms with history of diabetes and hypertension for 16 years. Patient was undergone two laparoscopic surgeries for peptic ulcer perforation in 1992 and 1997. Patient had epigastric pain, vomiting, poor oral intake and constipation two weeks before hospitalization. Patient was diagnosed with distal gastric obstruction and subtotal gastrectomy with Billroth II reconstruction was performed. Surgical nurse team had applied Orem’s theory of nursing system to all three phase of surgical nursing care to aggregate patient information and manage care plan which included 1) wholly compensatory system during perioperative phase 2) partially compensatory system during pre and post operative phase 3) supportive system and patient education before discharge. The potential risks of this patient were 1) risk of perioperative and post operative infection 2) risk of delayed or cancelled operation according to patient’s physical and mental status 3) risk of massive bleeding during operation 4) risk of hypothermia 5) risk of inadequate oxygen supplementation during patient transfer. Total surgical time was 2 hours and 15 minutes with 300 ml of blood loss. There was no serious complication during perioperative and post operative periods. Patient was gradually improved and able to manage self care before discharge. Total length of hospital stay was 16 days.
Conclusion: Nursing care plan in major surgery was complicated and require monitoring process เท all three phases of the surgery to prevent bleeding complication, shock and postoperative infection which may lead to patient’s mortality otherwise patient evaluation and perioperative nursing care were not promptly provided. Consequently, patient was safe from surgical complications and able to manage self care at home.