A Case Study on Open Chole

8/13/2019 A Case Study on Open Chole

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TABLE OF CONTENTS

I. Introduction 3

II. Objectives 4

III. Nursing Assessment

1. erson!" #istor$

1.1. !tient%s &ro'i"e (

1.). F!mi"$ !nd individu!" in'orm!tion (

1.3. Leve" o' gro*t+ !nd deve"o&ment

1.3.1. Norm!" deve"o&ment !t &!rticu"!r st!ge (,-

1.3.). T+e i"" &erson !t &!rticu"!r st!ge o' &!tient

). /i!gnostic 0esu"ts ,

3. resent &ro'i"e o' Function!" #e!"t+ !tterns ,11

4. !t+o&+$sio"og$ !nd 0!tion!"e

4.1. Norm!" !n!tom$ !nd &+$sio"og$ 1)

4.). Sc+em!tic di!gr!m 13

4.3. /ise!se &rocess !nd its e''ect on di''erent org!n2s$stem 14,1(

4.4. Com&!r!tive c+!rt 1(,1

I. Nursing Intervention

1. C!re guide o' &!tient 1,1

). Actu!" &!tient c!re5).1. Nursing c!re &"!ns 1,))

).). Bruns*ic6 "ens mode" )3

).3. SOAIE c+!rting )4,)(

).4. /rug t+er!&eutic record ),37

).(. #e!"t+ te!c+ing &"!n 31,3)

. Ev!"u!tion !nd recommend!tion 33

I. Ev!"u!tion !nd im&"ic!tion o' t+is c!se stud$ to5 33


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1. Nursing &r!ctice

). Nursing educ!tion

3. Nursing rese!rc+

II. Bib"iogr!&+$ 34

I. INTRODUCTION

T+e$ s!$ t+!t !"ong *it+ o"d !ge comes ! di''erent &ers&ective o'

+e!"t+. As m!n$ o' us 6no* t+e o"der *e get t+e more &rone *e !re to cert!in +e!"t+

&rob"ems !nd dise!ses. Suc+ is t+e c!se o' 8s. L!gur!9 Lourdes.

In O&en C+o"ec$stectom$9 t+e &!tient is &"!ced under gener!"

!nest+esi! !nd t+en ! surgic!" incision is m!de !t t+e rig+t u&&er :u!dr!nt o' t+e

!bdomen. T+e g!""b"!dder is t+en surgic!""$ removed !nd !ssessment o' ot+er org!ns

!re !"so done. T+e s&ecimen m!$ t+en be t!6en 'or bio&s$. T+e &ost ; o&er!tive

&eriod "!sts usu!""$ ! *ee6 but c!n sometimes t!6e mont+s de&ending on t+e &!tients%

+e!"t+ condition !nd i' !n$ ot+er com&"ic!tions occurred. /uring t+is time nursing

interventions !re centered not on"$ on reest!b"is+ment o' &+$sio"ogic b!"!nce !nd

&!in re"ie' but !"so on &reventing com&"ic!tions !nd &romoting inde&endence b$

te!c+ing t+e &!tient se"',c!re.

O&en C+o"ec$stectom$ is de'inite"$ not ! r!re &rocedure. In "ine *it+ t+is9 t+e

student decided to t!6e t+e o&&ortunit$ to m!6e ! c!se stud$ on t+e s!id to&ic not on"$

to g!in 'urt+er 6no*"edge on t+e s!id surgic!" &rocedure but !"so to "e!rn more !bout

t+e &ost,o&er!tive c!re given to suc+ &!tients. T+e +o&es !re t+!t t+is &!&er *ou"d

!"so be !b"e to guide ot+er students on t+e c!re rendered s+ou"d t+e$ encounter ! &ost,

o&en c+o"ec$stectom$ c"ient.

)


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1. PERSONAL HISTOR

1.1 P!tient"s Pr#$ile

8s. L!gur!9 Lourdes ! $r. o"d9 sing"e *om!n *!s !dmitted to Cebu

/octors% @niversit$ on Febru!r$ 19 )77 !nd *!s sc+edu"ed surgic!"

o&er!tion o' +er C+o"ec$sto"it+i!sis "!st Febru!r$ )79 )77. !tient *!s under

t+e c!re o' /r. 0ose""o.

1.% &!'il( !nd indi)idu!l in$#r'!ti#n* s#+i!l !nd ,e!lt, ,ist#r(

8s. L!gur!9 ! $r. o"d9 sing"e *om!n9 ! 0om!n C!t+o"ic !nd Fi"i&ino. S+e is

! retired te!c+er. S+e *!s e>&eriencing discom'orts !t +er rig+t u&&er :u!dr!nt

o' +er !bdomen *+ic+ turn out to be g!"" stones. T+is discover$ &rom&ted t+e

&!tient%s !dmission !nd surgic!" o&er!tion9 O&en C+o"ec$stectom$.

1.. Le)el #$ r#/t, !nd De)el#0'ent

P,(si+!l +,!nes

8ost e"der"$ e>&erience dec"ines in +e!ring9 vision9 t!ste9 !nd sme"". T+e$ !"so

e>&erience some dec"ines in t+eir !bi"it$ to detect &!in !nd notice tem&er!ture

c+!nges. T+ese dec"ines !re t$&ic!""$ gr!du!" !nd become more &ronounced in

"!te o"d !ge -7 . Ot+er +e!"t+ re"!ted issues inc"ude rising b"ood &ressure9

dec"ining "ung c!&!cit$9 !nd neur!" "oss. It is im&ort!nt to note t+!t dec"ines in

!"" t+ese !re!s c!n be gre!t"$ in'"uenced b$ one?s "i'est$"e. Some m!$ !"so

e>&erience c+!nges in t+eir se>u!"it$.

Ps(+,#s#+i!l de)el#0'ent

L!te Adu"t+ood5 (( or ( to /e!t+

Ego /eve"o&ment Outcome5 Integrit$ vs. /es&!ir

B!sic Strengt+s5 Disdom

Eri6son 'e"t t+!t muc+ o' "i'e is &re&!ring 'or t+e midd"e !du"t+ood st!ge !nd

t+e "!st st!ge is recovering 'rom it. er+!&s t+!t is bec!use !s o"der !du"ts *e

c!n o'ten "oo6 b!c6 on our "ives *it+ +!&&iness !nd !re content9 'ee"ing

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'u"'i""ed *it+ ! dee& sense t+!t "i'e +!s me!ning !nd *e?ve m!de ! contribution

to "i'e9 ! 'ee"ing Eri6son c!""s integrit$. Our strengt+ + comes 'rom ! *isdom

t+!t t+e *or"d is ver$ "!rge !nd *e no* +!ve ! det!c+ed concern 'or t+e *+o"e

o' "i'e9 !cce&ting de!t+ !s t+e com&"etion o' "i'e. On t+e ot+er +!nd9 some

!du"ts m!$ re!c+ t+is st!ge !nd des&!ir !t t+eir e>&eriences !nd &erceived

'!i"ures. T+e$ m!$ 'e!r de!t+ !s t+e$ strugg"e to 'ind ! &ur&ose to t+eir "ives9

*ondering D!s t+e tri& *ort+ it A"tern!tive"$9 t+e$ m!$ 'ee" t+e$ +!ve !""

t+e !ns*ers not un"i6e going b!c6 to !do"escence !nd end *it+ ! strong

dogm!tism t+!t on"$ t+eir vie* +!s been correct. T+e signi'ic!nt re"!tions+i&

is *it+ !"" o' m!n6indGm$,6ind.

Ps(+,#se2u!l de)el#0'ent

T+e


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T+e &ost,convention!" "eve"9 !"so 6no*n !s t+e &rinci&"ed "eve"9 consists o'

st!ges 'ive !nd si> o' mor!" deve"o&ment. 0e!"iH!tion t+!t individu!"s !re

se&!r!te entities 'rom societ$ no* becomes s!"ient. One?s o*n &ers&ective

s+ou"d be vie*ed be'ore t+e societ$. It is due to t+is ?n!ture o' se"' be'ore

ot+ers? t+!t t+e &ost,convention!" "eve"9 es&eci!""$ st!ge si>9 is sometimes

mist!6en 'or &re,convention!" be+!viors.

InStage fivesoci!" contr!ct driven9 individu!"s !re vie*ed !s +o"ding

di''erent o&inions!nd v!"ues. A"ong ! simi"!r vein9 "!*s !re reg!rded !s

soci!" contr!cts r!t+er t+!n rigid dictums. T+ose t+!t do not &romote t+e

gener!" *e"'!re s+ou"d be c+!nged *+en necess!r$ to meet the greatest

good for the greatest number of people.JT+is is !tt!ined t+roug+ m!jorit$

decision9 !nd inevit!b"$ com&romise. In t+is *!$ democr!tic government

is ostensib"$ b!sed on st!ge 'ive re!soning.

S0iritu!l de)el#0'ent

Individu!",0e'"ective eriod

Individu!" 'ocuses on re!"it$9 constructing ones o*n e>&"icit s$stemK

+ig+ degree o' se"',consciousness. oung !du"ts *+o need to !ns*er t+e

re"igious :uestions o' t+eir o*n c+i"dren m!$ 'ind t+!t t+e te!c+ing o' t+eir

o*n e!r"$ c+i"d+ood is more !cce&t!b"e to t+em no* t+!n during !do"escence.

De)el#0'ent!l t!s4s:

L!ter Adu"t+ood 7 to -(

romoting inte""ectu!" vigor

0edirecting energ$ to ne* ro"es !nd !ctivities

!do&ting ones "i'e

deve"o&ing ! &oint o' vie* !bout de!t+
http://en.wikipedia.org/wiki/Opinionshttp://en.wikipedia.org/wiki/Valueshttp://en.wikipedia.org/wiki/Social_contracthttp://en.wikipedia.org/wiki/Kohlberg's_stages_of_moral_development#_note-moralizationhttp://en.wikipedia.org/wiki/Majority_decisionhttp://en.wikipedia.org/wiki/Majority_decisionhttp://en.wikipedia.org/wiki/Compromisehttp://en.wikipedia.org/wiki/Democratic_governmenthttp://en.wikipedia.org/wiki/Opinionshttp://en.wikipedia.org/wiki/Valueshttp://en.wikipedia.org/wiki/Social_contracthttp://en.wikipedia.org/wiki/Kohlberg's_stages_of_moral_development#_note-moralizationhttp://en.wikipedia.org/wiki/Majority_decisionhttp://en.wikipedia.org/wiki/Majority_decisionhttp://en.wikipedia.org/wiki/Compromisehttp://en.wikipedia.org/wiki/Democratic_government


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1..% THE ILL PERSON AT THE PARTICULAR STAE

T+e c"ient !t &resent &!rticu"!r st!ge is m!ni'esting t+e norm!"

&+$sic!"9 emotion!" !nd cognitive deterior!tion t+!t is !ssoci!ted *it+ t+e

!ging &rocess. /ue to c"ient%s i"" st!tus9 t+e c"ient is +!ving di''icu"t$ in co&ing

*it+ +er !ging &rocess9 t+e s"o* degener!tive m!ni'est!tions &!rticu"!r"$ +er

&+$sic!" !ttributes. T+e !ddition!" tr!um! received 'rom +er surgic!" o&er!tion

!"so +inders +er !ctivities o' d!i"$ "iving9 !"tering +er diet !nd !ddition!"

discom'ort 'rom t+e &!in.

%. DIANOSTIC RESULTS

/i!gnostic Tests Norm!" !"ues !tient%s 0esu"ts Signi'ic!nce

CBC !s o' Febru!r$ )9 )77-

#emog"obin 14.7,1-.( d2dL 11.) g2dL/ecre!sed *it+ !nemi! or

!'ter b"ood "oss

#em!tocrit 41.(,(7.4M 33.3M Norm!"

DBC count

Neutro&+i"

Eosino&+i"

L$m&+oc$tes

8onoc$tes

49477,119777 1.) cu2mm Norm!"

47,-7M 7M Norm!"

7,(M 3M Norm!"

)7,47M 33M Norm!"

7,M 4M Norm!"

0BC 4.(,(. 17g2uL 4.4( 17g2uL/ecre!sed *it+ !nemi! or

!'ter b"ood "oss

-


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8e!n

Cor&uscu"!r7, 'L . 'L Norm!"

8e!n

Cor&uscu"!r #gB

)-.(,33.) &g ) &g Norm!"

8e!n

Cor&uscu"!r #gB

Concentr!tion

33.4,3(.(M 33.( &g Norm!"

"!te"ets 1(7,4(7 17g2L 314 17g2L Norm!"

Source5 8edic!",Surgic!" Nursing9 17t+Edition9 b$ Sme"tHer !nd B!re9 o". )9 &g.

))14 ; ))33

. PRESENT PRO&ILE O& &UNCTIONAL HEALTH

PATTERNS

1. He!lt, 0er+e0ti#n

T+e c"ient +!s undergone o&en c+o"$c$stectom$ !nd is sti"" in mi"d discom'ort

'rom t+e surgic!" tr!um!. S+e is *orried !bout +er *ound !nd +o* "ong it *ou"d

+e!" considering s+e +!s been di!gnosed *it+ di!betes me""itus *+ic+ cou"d s"o*

do*n +er +e!"ing &rocess. #o*ever t+e &!tient t+in6s t+!t i' s+e cou"d m!int!in

+er b"ood sug!r "eve" to norm!" s+e *ou"d +e!" in ! s+orter s&!n o' time. S+e does

not remember i' s+e is 'u""$ immuniHed but s+e t!6es c!re o' +er +e!"t+ 'o""o*ing

doctor%s orders !nd modi'ied +er diet to m!int!in +er b"ood &ressure !nd g"ucose

"eve".

%. Per+e0tu!l 0!ttern

T+e &!tient *e!rs g"!sses 'or re!ding !nd *riting. S+e sometimes com&"!ins

!bout +er +e!ring but s+e does not *e!r +e!ring !ids. S+e e>&resses t+!t s+e +!s

"ess sensitivit$ to &!in or sometimes touc+ but s+e e!si"$ gets co"d but +!s no

sensitivit$ to +e!t. 8ost o' t+e time s+e 'ee"s diHH$ !nd "ig+t +e!ded *+en s+e

moves sudden"$ or st!nds u& !'ter sitting or "$ing do*n in &ro"onged &eriods o'

time.


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. Sel$ 5 +#n+e0t

8s. L!gur! jo6es t+!t s+e is o"d !nd t+!t s+e is sic6"$. S+e s!$s t+!t s+e does +er

best to 6ee& +erse"' 'it !nd 6ee& +er di!gnosed &rob"ems in c+ec6 to !void !n$

com&"ic!tions. S+e s!$s s+e 6no*s +o* to t!6e c!re o' +erse"' !nd 6no* +o* to

modi'$ +er "i'est$"e !ccording"$.

6. Slee0 !nd rest

8s. L!gur! usu!""$ s"ee&s !t !round ; 17&m in t+e evening !nd *!6es u& !s

e!r"$ !s (577 in t+e morning s+e !"so t!6es n!&s in t+e !'ternoon. #o*ever9

during +er +os&it!" st!$ s+e s!$s s+e 're:uent"$ *!6es u& in t+e evening !s t+ere

!re medic!tions !nd vit!" signs to be t!6en. But s+e is not ver$ disturbed !s s+e

m!n!ges to s"ee& !g!in.

7. Nutriti#n!l !nd 'et!8#li+ 0!ttern

T+e &!tient%s usu!" int!6e is veget!b"es9 'is+ !nd not so muc+ on &or6. S+e +!s

!"so been !voiding too s!"t$ !nd too s*eet 'oods !s s+e is ! +$&ertensive di!betic.

T+oug+ s+e !dmits to +!ve e!ten 'ood t+!t s+ou"d be !voided s+e s!$s s+e is

com&"i!nt o' +er m!inten!nce medic!tions. S+e drin6s g"!sses or more o' *!ter

!nd st!tes t+!t s+e +!s m!int!ined +er *eig+t to 6ee& +erse"' !s +e!"t+$ !s s+e

cou"d be.

9. Eli'in!ti#n 0!ttern

T+e &!tient is on 'o"e$ b!g c!t+eter. S+e usu!""$ de'ec!tes e!r"$ morning

ever$d!$. But since +er o&er!tion s+e +!s not de'ec!ted 'or 4 d!$s. #er s6in is

*!rm9 but ! "itt"e bit $e""o*9 non,&ruritic !nd t+ere is s"ig+t edem!.

. A+ti)it( !nd E2er+ise 0!ttern

8s. L!gur! s!id t+!t s+e tries some e>ercises *+i"e sitting do*n *+enever s+e

c!n. #o*ever s+e com&"!ins t+!t s+e e!si"$ gets tired !nd becomes d$s&neic

sometimes !'ter muc+ e>ertion. A'ter surger$ s+e gu!rds +er movements !s it is

sti"" ! bit &!in'u" to move !round !nd s+e s!$s s+e is sc!red t+e stitc+es mig+t

come o''.


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;. r#le !nd rel!ti#ns,i0 0!ttern

8s9 L!gur! "ives *it+ +er sister. S+e +!s no c+i"dren !nd is retired !nd is "iving

o'' on +er &ension !nd some mone$ given b$ 'riends !nd re"!tives. /ecision

m!6ing is m!in"$ m!de b$ +er !nd +er sister de&ending on t+e situ!tion or m!tter

to be discussed.


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6.PATHOPHSIOLO AND RATIONALE

6.1 NOR3AL ANATO3 AND PHSIOLO O& ORAN

A&&ECTED:

T+e g!""b"!dder is ! sm!"" &e!r,s+!&ed org!n t+!t stores !nd concentr!tes bi"e.

T+e g!""b"!dder is connected to t+e "iverb$ t+e +e&!tic duct. It is

!&&ro>im!te"$ 3 to 4 inc+es -. to 17.) cm "ong !nd !bout 1 inc+ ).( cm

*ide.

T+e 'unction o' t+e g!""b"!dder is to store bi"e !nd concentr!te. Bi"e is !

digestive "i:uid continu!""$ secreted b$ t+e "iver. T+e bi"e emu"si'ies '!ts !nd

neutr!"iHes !cids in &!rt"$ digested 'ood. A muscu"!r v!"ve in t+e common bi"e

duct o&ens9 !nd t+e bi"e '"o*s 'rom t+e g!""b"!dder into t+e c$stic duct9 !"ong

t+e common bi"e duct9 !nd into t+e duodenum &!rt o' t+e sm!"" intestine.

11
http://www.mamashealth.com/organs/liver.asphttp://www.mamashealth.com/organs/liver.asp


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6.% SCHE3ATIC DIARA3 O& THE PATHOLO O& THE

DISEASE

1)

!t+o&+$sio"og$5

/ecre!se bi"e !cid s$nt+esis !nd incre!sed c+o"estero" s$nt+esis in t+e

"iver9 resu"ting in bi"e su&ers!tur!ted *it+ c+o"estero"9 *+ic+ &reci&it!tes

out o' t+e bi"e to 'orm stones. T+e c+o"estero" ; s!tur!ted bi"e

&redis&oses to t+e 'orm!tion o' g!"" stones !nd !cts !s !n irrit!nt9

&roducing in'"!mm!tor$ c+!nges in t+e g!"" b"!dder.

Signs !nd S$m&toms5

E&ig!stric distress suc+ !s 'u""ness

Abdomin!" distention

Bi"i!r$ co"ic

=!undice

C+!nges in urine !nd stoo" co"or it!min de'icienc$

F!ctors5

8ore in *omen t+!n in

men.

Above 47 $e!rs o' !ge.

Obesit$

#ig+ c+o"estero" "eve"s

Surgic!" 8!n!gement5

O&en c+o"ec$stectom$

L!&!rosco&ic

c+o"ec$stectom$

Lit+otri&s$8edic!" 8!n!gement5

8edic!tions5

- Antibiotics

- An!"gesics

#ig+ c!"orie diet

Cirr+osis

Bi"e st!sis

/i!betes

C$stic Fibrosis

Nursing 8!n!gement5

Encour!ge !mbu"!tion

Encour!ge dee& bre!t+ing

e>ercises !nd use o'

incentive s&irometr$

8onitor int!6e !nd out&ut

8onitor vit!" signs


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6. DISEASE PROCESS AND IT"S E&&ECTS ON THE ORAN OR SSTE3:

C,#lelit,i!sis

A"so 6no*n !s g!""stones9 t+ese +!rd m!sses !re 'ormed in t+e

g!""b"!dder or &!ss!ges9 !nd c!n c!use severe u&&er rig+t !bdomin!"

&!in r!di!ting to t+e rig+t s+ou"der9 !s ! resu"t o' b"oc6ed bi"e '"o*.

6..1 THE SURICAL OPERATION

A c+o"$c$stectom$ is t+e surgic!" remov!" o' t+e g!""b"!dder. T+e t*o b!sic t$&es o'

t+is &rocedure !re o&en c+o"$c$stectom$ !nd t+e "!&!rosco&ic !&&ro!c+. It is

estim!ted t+!t t+e "!&!rosco&ic &rocedure is current"$ used 'or !&&ro>im!te"$ 7M o'

c!ses.

A c+o"$c$stectom$ is &er'ormed to tre!t c+o"e"it+i!sis !nd c+o"ec$stitis. In

c+o"e"it+i!sis9 g!""stones o' v!r$ing s+!&es !nd siHes 'orm 'rom t+e so"id com&onents

o' bi"e. T+e &resence o' stones9 o'ten re'erred to !s g!""b"!dder dise!se9 m!$ &roduce

s$m&toms o' e>cruci!ting rig+t u&&er !bdomin!" &!in r!di!ting to t+e rig+t s+ou"der.

T+e g!""b"!dder m!$ become t+e site o' !cute in'ection !nd in'"!mm!tion9 resu"ting in

s$m&toms o' u&&er rig+t !bdomin!" &!in9 n!use! !nd vomiting. T+is condition is

13


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re'erred to !s c+o"ec$stitis. T+e surgic!" remov!" o' t+e g!""b"!dder c!n &rovide re"ie'

o' t+ese s$m&toms.

In ! convention!" or o&en c+o"$c$stectom$9 t+e g!""b"!dder is removed t+roug+ !

surgic!" incision +ig+ in t+e rig+t !bdomen9 just bene!t+ t+e ribs. A dr!in m!$ be

inserted to &revent !ccumu"!tion o' '"uid !t t+e surgic!" site.

As *it+ !n$ surgic!" &rocedure9 t+e &!tient *i"" be re:uired to sign ! consent 'orm

!'ter t+e &rocedure is e>&"!ined t+oroug+"$. Food !nd '"uids *i"" be &ro+ibited !'ter

midnig+t be'ore t+e &rocedure. Enem!s m!$ be ordered to c"e!n out t+e bo*e". I'

n!use! or vomiting is &resent9 ! suction tube to em&t$ t+e stom!c+ m!$ be used9 !nd

'or "!&!rosco&ic &rocedures9 ! urin!r$ dr!in!ge c!t+eter *i"" !"so be used to decre!se

t+e ris6 o' !ccident!" &uncture o' t+e stom!c+ or b"!dder *it+ insertion o' t+e troc!r !

s+!r&,&ointed instrument.

6.6 CO3PARATIVE CHART

C"!ssic!" s$m&toms C"inic!" s$m&toms 0!tion!"e

OSTOE0ATIE

Surgic!" incision

osto&er!tive &!in

#$&otension#emorr+!ge

8!ni'ested

,! 17,1(cm incision *!s

m!de t+roug+ t+e !bdomen

to remove g!""b"!dder

8!ni'ested

,&!tient is re"uct!nt to

bre!t+e dee&"$ due to t+e

&!in c!used b$ t+e

&ro>imit$ o' t+e incision to

t+e musc"es used 'or

res&ir!tion. T+e &!tient *!s

s+o*n +o* to su&&ort t+e

o&er!tive site *+en

bre!t+ing dee&"$ !nd

coug+ing9 !nd given &!in

medic!tion !s necess!r$.

Not 8!ni'ested

,! necess!r$ &!rt o' t+e

surgic!" &rocedure

,due to tissue tr!um! 'rom

&rocedure

,resu"t 'rom b"ood "oss,m!$ occur due tr!um! o'

14


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N!use! !nd vomiting

8!"ign!nt +$&ert+ermi!

0es&ir!tor$ com&"ic!tion

Consti&!tion

@rin!r$ retention

An>iet$

Not m!ni'ested

Not 8!ni'ested

Not m!ni'ested

Not 8!ni'ested

8!ni'ested

, &!tient +!s not been !b"e

to de'ec!te since t+e

&rocedure *!s done

Not 8!ni'ested

Not m!ni'ested

t+e surgic!" &rocedure

,side e''ect o' !nest+esi!

,c+emic!""$ induced b$!nest+etic !gents

,!nest+etic !gents c!n c!use

res&ir!tor$ de&ression or

!s&ir!tion o' res&ir!tor$ tr!ct

secretion or vomitus

,'rom decre!se in mobi"it$

!nd or!" int!6e !nd due to

t+e o&ioid !n!"gesics used

,!nest+etics !nd o&ioids m!$

inter'ere *it+ t+e &erce&tion

o' b"!dder 'u""ness !nd t+e

urge to void

,m!$ be 'rom &!in9 ne*

environment9 "!c6 o' contro"9

'!tigue

Source5 8S b$ Brunner !nd

Sudd!rt+9 1t+ed.

IV. NURSIN INTERVENTION

1. C!re uide #$ P!tient /,# ,!s under#ne O0en C,#le+(ste+t#'(

osto&er!tive c!re begins in t+e o&er!ting room immedi!te"$ !'ter surger$ !nd

continues in t+e &ost!nest+esi! c!re unit AC@ !s *e"" !s during t+e d!$s

!'ter t+e &rocedure. F!ctors !''ecting t+e e>tent o' c!re re:uired !re5 t+e

origin!" +e!"t+ st!tus o' t+e &!tient9 t$&e o' surger$9 !nd *+et+er t+e surger$

*!s &er'ormed in ! d!$,surger$ setting or in t+e +os&it!". /!$,surger$ centers

o&er!te on !n out &!tient b!sis !nd intensive monitoring is done in t+e 'e*

+ours &osto&er!tive"$ t+!t t+e &!tient rem!ins in t+e center. S+ou"d !n$

com&"ic!tions occur9 t+en t+e &!tient is sent to t+e +os&it!". !tients !dmitted

1(


16/30

in t+e +os&it!" m!$ re:uire !n$t+ing bet*een ! d!$ to *ee6s o' &osto&er!tive

c!re be'ore t+e$ !re disc+!rged. osto&er!tive c!re inc"udes5

Pre)entin res0ir!t#r( +#'0li+!ti#ns - T+e &!tient is encour!ged to turn

're:uent"$ !nd t!6e dee& bre!t+s !t "e!st ever$ ) +ours to c"e!r secretions !nd&revent &neumoni!. Coug+ing is !"so encour!ged to dis"odge mucus &"ugs.

T+is is done *it+ ! &i""o* !s ! s&"int to "essen &!in on incision site

overcome 'e!r o' undoing t+e stitc+es. An!"gesics m!$ !"so +e"& !s o>$gen

m!$ be given vi! c!nnu"! to &revent or re"ieve +$&o>i!.

En+#ur!in !+ti)it( - Surgic!" &!tients !re encour!ged to be out o' bed !ssoon !s &ossib"e. E!r"$ !mbu"!tion reduces t+e incidence o' &osto&er!tive

com&"ic!tions9 incre!ses venti"!tion9 reduces t+e st!sis o' bronc+i!" secretions

in t+e "ungs9 !nd reduces &osto&er!tive !bdomin!" distention b$ incre!sing t+e

musc"e tone o' t+e !bdomin!" *!"" tone !nd stimu"!ting &erist!"sis.

Pr#'#tin /#und ,e!lin - eriodic !ssessment o' surgic!" site is done.T+e *ound edges9 integrit$ o' sutures or st!&"es !re ins&ected 'or in'ection9

redness9 *!rmt+9 s*e""ing9 unusu!" tenderness or dr!in!ge. It s+ou"d !"so be

ins&ected 'or re!ctions to t!&e or tr!um! 'rom tig+t b!nd!ges.

Dressin C,!nes - T+e 'irst &osto&er!tive dressing is usu!""$ c+!nged b$! member o' t+e surgic!" te!m. Subse:uent dressing c+!nges9 +o*ever9 !re !t

times done b$ t+e nurse. A dressing is !&&"ied to &rovide ! &ro&er environment

'or *ound +e!"ing9 !bsorb dr!in!ge9 s&"int or immobi"iHe t+e *ound9 &rotect

t+e *ound !nd ne* e&it+e"i!" tissue 'rom mec+!nic!" injur$9 &rotect t+e

*ound 'rom b!cteri!" cont!min!tion !nd 'rom soi"ing9 &romote +omeost!sis9

!nd to &rovide ment!" !nd &+$sic!" com'ort to t+e &!tient

3!int!inin n#r'!l 8#d( te'0er!ture - T+e &!tient is !t ris6 'orm!"ign!nt +$&ert+ermi! !nd +$&ot+ermi! in t+e &osto&er!tive &eriod. T+e

room is m!int!ined !t ! com'ort!b"e tem&er!ture9 !nd b"!n6ets !re &rovided.

Tre!tment inc"udes o>$gen !dministr!tion9 !de:u!te +$dr!tion !nd &ro&er

nutrition. T+e &!tient is !"so monitored 'or c!rdi!c d$sr+$t+mi!s. T+e ris6 'or

+$&ot+ermi! is gre!ter in t+e e"der"$ !nd in &!tients *+o *ere in t+e coo"

o&er!ting room 'or ! "ong time.

3!int!inin !str#intestin!l $un+ti#n !nd resu'in nutriti#n

1


17/30

T+e &!tient m!$ not be !""o*ed to e!t &ost o& !s t+e e''ects o' t+e !nest+esi!

c!uses reduced bo*e" movement. So t+e &!tient is &"!ced on tem&or!r$ NO.

T+e &!tient m!$ on"$ st!rt "i:uid diet *+en s+e is !b"e to &roduce g!s !nd on

'u"" diet *+en s+e is !b"e to remove +er bo*e" contents *+ic+ is ! sign o'

bo*e" movement.

Pr#'#tin 8#/el $un+ti#n - E!r"$ !mbu"!tion9 im&roved diet!r$ int!6e9!nd ! stoo" so'tener &romote bo*e" e"imin!tion. @nti" t+e &!tient re&orts return

o' norm!" bo*e" 'unction9 t+e nurse s+ou"d !ssess t+e !bdomen 'or distention

!nd t+e &resence !nd 're:uenc$ o' bo*e" sounds.

3!n!in )#idin - B"!dder distention !nd t+e urge to void s+ou"d be!ssessed on t+e &!tient%s !rriv!" on t+e unit !nd 're:uent"$ t+ere!'ter. T+e

&!tient is e>&ected to void *it+in +ours !'ter surger$. I' t+e &!tient +!s !n

urge to void but c!nnot void9 c!t+eteriH!tion m!$ be done.

3!n!in ! s!$e en)ir#n'ent - Bec!use t+e &!tient rem!ins grogg$during t+e immedi!te &osto&er!tive &eriod9 t+e sider!i"s s+ou"d be u&9 !nd t+e

bed s+ou"d be in t+e "o* &osition to &revent '!""s. Ot+er immedi!te

&osto&er!tive orders invo"ve s&eci!" &ositioning9 e:ui&ment9 or intervention.

T+e &!tient is instructed to !s6 'or !ssist!nce *it+ !n$ !ctivit$.

Pr#)idin e'#ti#n!l su00#rt t# t,e 0!tient !nd $!'il( - T+e nurse +e"&st+e &!tient !nd t+e '!mi"$ *or6 t+roug+ t+eir !n>ieties b$ &roviding

re!ssur!nce !nd in'orm!tion !nd b$ s&ending time "istening to !nd !ddressing

t+eir concerns. T+e '!mi"$ s+ou"d be &re,oriented to t+e &!tient%s

&osto&er!tive "oo6 suc+ !s &resence o' tubes !nd t+e siHe o' incisions to

&re&!re t+em !nd 6ee& t+em c!"m in 'ront o' t+e &!tient.

1-


18/30

1


19/30

CEB@ /OCTO0S? @NIE0SIT

COLLE Needs Nursin

Di!n#sis

S+ienti$i+ B!sis O8?e+ti)e

#$ C!re

Nursin A+ti#ns

I. +$sio"ogic

A. Over"o!d

1. A"tered com'ort5 &!in

, st!tus 1 d!$ &ost, o&en

c+o"ec$stectom$.

, *it+ surgic!" *ound !t

mid"ine 'rom "o*er rib do*n

&!st umbi"ic!" "eve"

, *it+ ! surgic!" *ound !t t+e

rig+t u&&er :u!dr!nt o'

!bdomen

, re&orts &!in on movement

t+!t is - out o' 17on &!in sc!"e

,c"ient describes &iercing &!in

'e"t !t incision site u&on

movement o' !bdomen !nd

!nterior c+est "!sting 'or ),(

minutesK !ggr!v!ted b$ sudden

mov%ts coug+ingK re"ieved

b$ !n!"gesics !nd s+!""o*

bre!t+ing

, gu!rded movements !nd

A"tered

com'ort5

&!in9

re"!ted to

tissue

tr!um!

second!,

r$ to

surgic!"

o&er!tion

8ost &!tients

e>&erience some &!in

!'ter ! surgic!"

&rocedure. 8!n$

'!ctors in'"uence t+e

&!in e>&erience. T+e

degree !nd severit$ o'

&osto&er!tive &!in !nd

t+e &!tient%s to"er!nce

'or &!in de&end on t+e

incision site9 t+e

n!ture o' t+e surgic!"

&rocedure9 t+e e>tent

o' surgic!" tr!um!9 t+e

t$&e o' !nest+etic

!gent9 !nd +o* t+e

!gent *!s

!dministered.

Source5 Fund!ment!"s

o' Nursing b$ otter

err$ &. 44

A'ter +rs.

o' SN,

&!tient

inter!ction9

t+e &!tient

*i"" be !b"e

to5

1. verb!"iHe

re"ie' o'

&!in !s

evidenced

b$ ! &!in

sc!"e o' 4

out o' 17

8e!sures to5

1. !""evi!te &!in

1.1 encour!ge !de:u!te rest

1.) &rovide com'ort me!sures

b!c6rub9 &osition c+!nge9

environment!" contro"

1.3 encour!ge dee& bre!t+ing

e>ercises

1.4 &osition &!tient on

o&timum com'ort

1.( monitor vit!" signs

1. observe non verb!" cues

i.e. '!ci!" grim!ce

1.- !dminister &!in

medic!tion &er doctor%s order

&rior to e>ercise or !ctivities

o' d!i"$ "iving

1


20/30

'!ci!" grim!ce noted

B. /e'icit

1. 0is6 'or in'ection

, st!tus 1 d!$ &ost,E>. L!&.

, *it+ surgic!" *ound !t

mid"ine 'rom "o*er rib do*n

&!st umbi"ic!" "eve" st!b

*ound !t "e't !nterior c+est

*it+out 'ou" odor or disc+!rges

, re&orts intermittent ting"ing !t

itc+iness !t incision site

, seen m!ni&u"!ting incision

site *it+ un*!s+ed +!nds

, PQ!to" !ng !6o t!+i

us!+!$9 norm!" r!

n!R

). Im&!ired &+$sic!" mobi"it$

, re&orts &iercing &!in u&on

movement t+!t is r!ted - out o'

17 on &!in sc!"e9 !ggr!v!ted b$

sudden movements9 re"ieved

b$ !n!"gesics

, gu!rded movements !nd

0is6 'or

in'ection5

&resence

o' o&er!,

tive

*ound9

re"!ted to

in!de,

:u!te

&rim!r$

de'enses

second!,

r$ to

surgic!"

incision

site

Im&!ired

&+$sic!"

mobi"it$5

"imited

move,

ments9

re"!ted to

&!in

Tr!nsmission o'

in'ective !gent 'rom !

source b$ !

susce&tib"e +ost occurs

*it+ t+e environment.

Org!nisms "ive !nd

mu"ti&"$ in reservoir

*+ic+ c!n be ! &erson9

!nim!"9 or &"!nt or

combin!tion o'

subst!nces. Dound

se&sis is common

occurrence !'ter

surger$. It is usu!""$

+er!"ded b$ incre!sed

&!in !nd '"uctu!ting

tem&er!ture. T+e

*ound s+ou"d be

ins&ected d!i"$ 'or

s*e""ing !nd "oc!"

tenderness.

Source5 8S b$ B"!c69

t+ed.

In t+e 'irst 'e* d!$s

!'ter surger$9 energ$

reserve is "imited !nd

tr!nsitor$. D+en

&!tient is !"so

grieving9 "!c6 o'

energ$ reserve is even

more !&&!rent. /uring

). identi'$

interven,

tions to

&revent

in'ection

reduce ris6

'or !c:ui,

ring it.

3.verb!"iHe

demon,

str!te

*i""ingness

to &!rtici,

&!te in

!ctivities

). &revent in'ection

).1 use !se&tic tec+ni:ue

*+en c+!nging dressing

).) ins&ect t+e incision site

'or in'"!mm!tion

).3 6ee& !re! c"e!n !nd dr$

).4 note !nd record

c+!r!cteristics o' dr!in!ge on

dressing

).( !&&"$ +e!t !nd co"d

). c"e!n t+e *ound regu"!r"$

).- !dminister !ntibiotics !s

&rescribed

3.incre!se &+$sic!" mobi"it$

3.1 &osition &!tient to

o&timum com'ort

3.) &romote medic!"

m!n!gement 'or &!in

3.3 &rovide s!'et$ me!sures

!s indic!ted

3.4 im&"ement 0O8

)7


21/30

'!ci!" grim!ce *it+ movements

noted

, un!b"e to tr!ns'er !nd

!mbu"!te &!in"ess"$

, decre!sed musc"e strengt+

, needs +e"& *it+ !ctivities

, com&"!ins o' '!tigue &!in

, re&orts in!bi"it$ to move

bo*e" 'or ) d!$s2

, R/i n!"!ng g!ni 6o mu"i+o6

6!i 6ut!s!n 6o n$! s!6it m!n.R

second!,

r$ to

surgic!"

o&er!tion

t+is d!$s o' '!tigue9

more !mbu"!tion is

re:uired !nd

incre!sing e>ercise

e>&ected.

Source5 8S b$ +i&&s

!nd Long

e>ercises

3.( encour!ge &!rtici&!tion

o' se"',c!re !ctivities

3. &romote &rogressive

mobi"iH!tion to m!>imum

*it+in "imits o' &!tient%s

to"er!nce to &!in

3.- encour!ge re&ositioning

*+i"e in bed

)1


22/30

%. SOAPIE CHARTIN

SOAIE 1 Febru!r$ )-9 )77

S, PS!6it ; s!6it &! jud t!*n i"i+o6 d!$R !s verb!"iHed b$ t+e &!tient

O, Seen &!tient "$ing do*n9 !*!6e9 conscious9 communic!tive9 co+erent9 *it+ I

( /(L0 1 "iter in'using *e"" !t "e't 'ore!rmK st!tus 1 d!$ &ost,o&en

c+o"ec$stectectom$ *it+ surgic!" *ound !t rig+t u&&er :u!dr!nt o' !bdomen9 no

disc+!rges on dressing9 no 'ou" odorK &!in u&on movement is r!ted - out o' 17 on

&!in sc!"e9 &iercing &!in 'e"t !t incision site u&on movement o' !bdomen !nd

!nterior c+est "!sting 'or ),( minutes9 !ggr!v!ted b$ sudden movements !nd

coug+ing9 re"ieved b$ !n!"gesics !nd s+!""o* bre!t+ing9 gu!rded movements !nd

'!ci!" grim!ce notedK *it+ vit!" signs o' B5 13727 mm#g9 T5 3. oC9 5

b&m9 05 )4 b&m

A, A"tered com'ort5 &!in9 re"!ted to tissue tr!um! second!r$ to o&er!tive

&rocedure

, To reduce &!in to ! sc!"e o' 4 out o' 17

I, monitored vit!" signs9 encour!ged !de:u!te rest9 &rovided com'ort me!sures9

encour!ged dee& bre!t+ing !nd incentive s&irometr$ e>ercises9 &ositioned &!tient

'or o&timum com'ort9 observed non verb!" cues9 !dministered !n!"gesics !s

&rescribed

E, Pt+e &!in seems to "essen !'ter I too6 t+e medic!tionR

SOAIE ) Febru!r$ )9)77

S, PQ!to" !ng !6o t!+i us!+!$9 norm!" r! n!R !s verb!"iHed b$ t+e &!tient

O, Seen &!tient "$ing do*n9 !*!6e9 conscious9 communic!tive9 co+erentK *it+ I

( /(L0 1 "iter in'using *e"" !t "e't 'ore!rmK st!tus 3 d!$s &ost,e>&"or!tor$

"!&!rotom$ *it+ surgic!" *ound !t rig+t u&&er :u!dr!nt o' t+e !bdomen9 nodisc+!rges on dressing9 no 'ou" odor $et &!tient is noted to regu"!r"$ m!ni&u"!te

site *it+ un*!s+ed+!ndsK *it+ vit!" signs o' B5 1372-7 mm#g9 T5 3-.) oC9 5 4

b&m9 05 1 b&m

A, 0is6 'or in'ection5 &resence o' &osto&er!tive *ound9 re"!ted to in!de:u!te

&rim!r$ de'enses second!r$ to surgic!" o&er!tion

, To &romote time"$ *ound +e!"ing !nd reduce ris6 'or in'ection

I, vit!" signs monitored9 used !se&tic tec+ni:ue in dressing *ound9 ins&ected site

'or in'"!mm!tion9 6e&t site c"e!n !nd dr$9 stressed im&ort!nce o' &ro&er

))


23/30

+!nd*!s+ing9 discour!ged scr!tc+ing o' *ound9 noted c+!r!cteristic o' disc+!rges

on dressing

E, PI"! r! m!n ni i.c+!nge !6o dressing miss s!R

)3


24/30

%.6 HEALTH TEACHIN PLAN

OBJECTIVES CONTENT 3ETHODOLO

ercises !re

e>ercises done *+ere ! "!rge vo"ume

o' !ir is in+!"ed !nd e>+!"ed

&romoting o&timum "ung e>&!nsion

Im&ort!nce5

).1 &romotes !de:u!te o>$gen!tion

).) &romotes !ir*!$ c"e!r!nce

).3 im&roves res&ir!tor$ res&onse

).4 &romotes re"!>!tion !nd com'ort

).( &romotes "ung e>&!nsion

8et+od2Tec+ni:ue used53.1 &"!ce +!nds be"o* t+e c"!vic"es

In'orm!"

/iscussion

In'orm!"

/iscussion

In'orm!"/iscussion9

)4


25/30

4. e>+ibit &ositive !ttitude in

c!rr$ing out t+e &rocedure

"e!rned

(. verb!"iHe 'ee"ings *it+

reg!rds t+e !ctivit$ !nd

inter!ction *it+ t+e student

nurse

e>erting moder!te &ressure

3.) !s6 t+e c"ient to in+!"e 'or (

seconds !s6 +im or +er to

concentr!te on e>&!nding t+e u&&erc+est 'or*!rd !nd u&*!rd *+i"e

in+!"ing to !er!te t+e !&ic!" "obes o'

t+e "ungs

3.3 !s6 c"ient to +o"d bre!t+ 'or 3,4

seconds to &romote !er!tion o' t+e

!"veo"i

3.4 !s6 c"ient to e>+!"e &!ssive"$ !nd

s"o*"$ 'or seconds t+roug+ t+e

mout+

3.( re&e!t e>ercises 'or 1(

res&ir!tions 4 times &er d!$

Encour!ge c"ient to !s6 :uestions

!nd voice out concerns reg!rding

&rocedure.

Encour!ge c"ient to !s6 :uestions

!nd voice out concerns reg!rding

&rocedure.

/emonstr!tion9

!nd 0eturn

/emonstr!tion

O&en S+!ring

O&en S+!ring

)(


26/30

DRU THERAPEUTIC RECORD

/rug2/ose2

Fre:uenc$2

0oute

C"!ssi'ic!tion2

8ec+!nism

Indic!tion2 Side,e''ects2 Contr!indic!tion rinci&"es O' C!re

1. Co,

Amo>ic"!v

Augmentin

77 mg I :

+ours

1)&m,&m,

4!m

Antimicrobi!"K

Antiin'ectives

#inders t+e ce""

*!"" s$nt+esis

o' sensitive

b!ctericid!"

!g!inst m!n$

gr!m ,

b!cteri!

I5 u&&er res&ir!tor$ in'ections9 sinusitis9

tonsi""itis9 bronc+itis9 bronc+o&neumoni!9

c$stitis

S2E5

#$&ersensitivit$ 0e!ctions5 Angioneurotic

edem!9 !n!&+$"!>is9 serum sic6ness,"i6e

s$ndrome9 +$&ersensitivit$ v!scu"itis.

S6in r!s+ &ruritis !nd urtic!ri! +!ve been

re&orted occ!sion!""$. Ot+er re!ctions

inc"uding er$t+em! mu"ti'orme9 Stevens,

=o+nson s$ndrome9 to>ic e&iderm!"

necro"$sis !nd bu""ous e>'o"i!tive

derm!titis9 !nd !cute gener!"ised

e>!nt+em!tous &ustu"osis Atr!n

or bic!rbon!te.

Store !t (C.

)


27/30

di!rr+e!9 n!use!9 vomiting !nd indigestion.

8ucocut!neous c!ndidi!sis !nd !ntibiotic,

!ssoci!ted co"itis inc"uding

&seudomembr!nous co"itis !nd

+!emorr+!gic co"itis +!ve been re&orted

r!re"$.

N!use! is more o'ten !ssoci!ted *it+

+ig+er or!" dos!ges. I' g!strointestin!"

re!ctions !re evident9 t+e$ m!$ be reduced

b$ t!6ing Augmentin !t t+e st!rt o' ! me!".

#e&!tic E''ects5 A moder!te rise in AST

!nd2or ALT +!s been noted in &!tients

tre!ted *it+ ,"!ct!m c"!ss !ntibiotics9 but

t+e signi'ic!nce o' t+ese 'indings is

un6no*n. #e&!titis !nd c+o"est!tic

j!undice +!ve been re&orted r!re"$

C2I5 +$&ersensitivit$K +istor$ o' c+o"est!tic

j!undice2 +e&!tic d$s'unction.

). 0!nitidine

U!nt!c (7

mg ITT : +ours

!m,&m

!nt!gonist. It in+ibits b!s!"

!nd stimu"!ted secretion o'

g!stric !cid9 reducing bot+

t+e vo"ume !nd t+e !cid !nd

I5/uoden!" !nd g!stric u"cersK


28/30


29/30

V. EVALUATION AND RECO33ENDATION

Pr#n#sis

T+ere *!s !n im&rovement in &!tient?s condition. B$ d!$s &ost o&er!tive9

t+ere *!s im&rovement in s6in co"or. 8ore im&rovement to*!rds o&timum +e!"t+ c!n

be e>&ected.

VI. EVALUATION AND I3PLICATION O& THIS CASE STUD TO:

Nursin Pr!+ti+e

T+is c!se stud$ is ge!red to*!rds &roviding !de:u!te 6no*"edge9 deve"o&ing

&ositive !ttitude9 !nd &ro&er s6i""s in c!ring 'or &osto&er!tive &!tients most

s&eci'ic!""$ t+ose undergoing O&en c+o"ec$stectom$.

Nursin Edu+!ti#n

T+is c!se stud$ !ims to +e"& t+e nursing students become e''icient nurses b$

&roviding 6no*"edge !bout t+e surgic!" o&er!tion9 its &rocedures9 t+e &osto&er!tive

&!tient !nd !""o*s +im or +er to be !b"e to 'ormu"!te nursing interventions !nd !

+e!"t+ te!c+ing &"!n !&&ro&ri!te 'or t+e c"ient. Ensuring t+e student +!s !de:u!te

6no*"edge !"so gives +im or +er ! sense o' con'idence !nd re!diness to c!re 'or t+e

&osto&er!tive c"ient.

Nursin Rese!r+,

T+is stud$ o' m!$ be used !s b!sis 'or 'uture rese!rc+ers o' t+is 6ind o'

surgic!" o&er!tion. It c!n !"so &rovide in'orm!tion needed b$ ot+er students so t+e$

m!$ underst!nd t+e &rocedure !nd t+e c!re needed b$ &osto&er!tive c"ients.

)


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VIII. BIBLIORAPH

Beers9 8!r6. T+e 8erc6 8!nu!" o' 8edic!" In'orm!tionK )nd edition 5 8erc6 Co.9

Inc.9 )773.

Brunner !nd Sudd!rt+. Te>tboo6 o' 8edic!" ; Surgic!" nursing .t+ Edition5

Li&&incott Di""i!ms !nd Di"6ins9 Inc.5 ))- E!st D!s+ington S:u!re9

+i"!de"&+i!. A9 179 )777.

/oenges9 8!rt"$nn E.9 8oor+ouse9 8!r$ Fr!nces9 !nd

A Case Study on Open Chole

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