PRN0098C Lecture Notes - Lecture 3: Aortic Aneurysm, Mammaplasty, Plastic Surgery

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alexandrasearle

31 Jan 2023

School

SJRSC, St Johns River Community College

Department

Nursing And Allied Health

Course

PRN0098C

Professor

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Document Summary

Chapter 12: nursing care of patients having surgery. Emergency - immediately needed to save life or limb without delay. Ruptured aortic aneurysm or appendix, traumatic limb amputation, loss of extremity pulse from emboli. Aesthetic - requested by patient for improvement. Diagnostic - obtain tissue samples, make an incision, or use a scope to make a diagnosis. Exploratory - confirmation or measurement of extent of condition. Preventive - removal of tissue before it causes a problem. Curative - removal of diseased or abnormal tissue. Reconstructive - correction of defects of body parts. Scar repair, total knee replacement, face lift, mammoplasty. Palliative - alleviation of symptoms when disease can"t be cured. Debulking to relieve pain/pressure, colostomy for incurable bowel obstruction, insertion of gastrostomy tube to provide tube feedings for swallowing problem, rhizotomy (cuts nerve root to relieve pain) Flexible tube with light, camera, and suction attached. One arm: camera, two arms: surgical hands, fourth arm: moves obstructions out of way.

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CASE STUDY:

Jolinda Hobble had a history of her left knee slipping out of joint since 1998. She went to see Dr. Ralph J. Verygood, an orthopedic surgeon who recommended corrective surgery after Jolinda had a major dislocation of the left kneecap in July of 2000. As a result of this surgery, Jolinda suffers from palsy of her left foot, a condition evidenced by numbness in her big toe and three adjoining toes, the numbness extending about half way up her foot on both the top and the bottom. Jolinda was advised that she might still experience postsurgical knee problems, including inability to walk altogether. She also says that she was not specifically warned about possible postsurgical numbness to either her left leg or foot. Dr.Verygood says that he did indeed warn Jolinda about this possibility.

The surgery was performed July 31, 2000. Jolinda was placed under general anesthetic and remained unconscious throughout the operation. Dr. Verygood performed a surgical procedure which has the effect of realigning the entire mechanism controlling the kneecap in order to correct the knee dislocation. During the operation a pneumatic tourniquet was applied to Jolinda's leg to help the operation procedure by cutting off the blood supply to the leg to create a dry (bloodless) surgical field. Following surgery Jolinda's leg was wrapped by Nurse Vicky with a padded dressing consisting of expandable bandage extending from the toes to the top of her leg. Nurse Vicky is an employee of the hospital.

Dr. Verygood was scheduled to take a few days vacation after the operation, but he nevertheless checked on Jolinda in the recovery room within one hour of the surgery. He also wrote detailed orders to be followed during his absence.

Jolinda says that she first awakened around dinner time on the day surgery was performed, but that she did not regain full consciousness until the following morning. At that time she became aware of a throbbing pain in her left leg which was concentrated on the knee and foot. Jolinda first complained about the pain to the hospital nurse, Nicky the morning after surgery. Nothing was done about the pain, however, until she was checked by Dr. Greatman, Dr. Verygood's partner, on the second postoperative day. Following Dr. Greatman's visit, Jolinda's bandages were cut off in the foot area giving her some relief and after which she experienced a tingling sensation throughout the whole foot.

Jolinda received follow up care from Dr. Verygood after surgery for about one year and during this time period Jolinda's complaints of pain and numbness in her left foot continued.

Here is some more information to consider: You end up hiring for your expert, Dr. Richard Cutgood, a board certified orthopedic surgeon, who had performed literally thousands of knee surgeries in his medical career. Dr. Cutgood is of the opinion that the risk of the type of injuries Jolida has following this type of surgery was statistically nonexistent.

Dr. Cutgood concluded that the most probable cause of plaintiff's injury was external pressure either from the tourniquet used during surgery or from the application of tight bandages after the operation. He considered the probability of nerve damage during the actual surgical procedure to be small because the surgical knife "isn't long enough to reach over and cut that nerve." Regarding the tourniquet, from his experience tourniquet pressure ordinarily does not result damage to the nerves unless "it is incorrectly applied or it is applied over a bony prominence or the tourniquet itself is defective."

Dr. Cutgood stated that while nothing in the record indicated that defendant did anything wrong during the surgery, he was of the opinion defendant was "below the usual and customary standard of care" as such result "does not generally occur without some untoward action of the surgeon."

Does the doctrine of Res Ipsa Loquitor apply to this case? What does this legal term mean? What are the conditions that need to be present for this doctrine to apply?

ibarra091521

Do any of these instructional notes apply to this scenario?

EXCLUDES: Lung removal with bronchoplasty (32501)

Code also decortication (32320)

Code also excision of chest wall tumor, when performed (21601-21603)

Documentation:

PREOPERATIVE DIAGNOSIS: Mass of lung

POSTOPERATIVE DIAGNOSIS: Carcinoma of the right lung

OPERATION PERFORMED: Bronchoscopy and right upper lobectomy

The patient was brought into the operating room, and after the

administration of anesthesia, the patient was prepped and draped in the usual sterile fashion. The patient was placed in the left lateral decubitus

position. A thoracotomy incision was made. This exposed the chest

muscles, which were incised and retracted. The fourth and fifth ribs were

visualized and transected to allow entrance to the chest. A tumor mass was

noted. This mass measured 7.0 cm in diameter, involving the right lung

upper lobe. The mass was excised in its entirety, and a biopsy of the mass

was taken and sent for frozen section. The frozen section revealed

squamous cell carcinoma. Nodes were then dissected around the pulmonary

artery and the trachea. The nodes were sent for frozen section. The nodes

were identified as negative per pathology. Saline was irrigated into the

chest. It was noted that the liver and diaphragm appeared to be normal with

no lesions seen. After verification that the sponge count was correct, chest

tubes were placed for drainage. The surgical wound was closed in layers

with chromic catgut and nylon. The patient tolerated this portion of the

procedure well.

The patient was then placed in the supine position for the bronchoscopy.

The patient was still under anesthesia. A flexible fiberoptic bronchoscope

was inserted. Patient bronchi were noted bilaterally. The scope was

withdrawn. The patient was awakened and sent to the recovery area in

stable condition.

a. Yes

b. No

StewartRenee

What procedure(s) will you need to code? (Check all that apply.)

Documentation:

PREOPERATIVE DIAGNOSIS: Mass of lung

POSTOPERATIVE DIAGNOSIS: Carcinoma of the right lung

OPERATION PERFORMED: Bronchoscopy and right upper lobectomy

The patient was brought into the operating room, and after the

administration of anesthesia, the patient was prepped and draped in the usual sterile fashion. The patient was placed in the left lateral decubitus position. A thoracotomy incision was made. This exposed the chest muscles, which were incised and retracted. The fourth and fifth ribs were visualized and transected to allow entrance to the chest. A tumor mass was noted. This mass measured 7.0 cm in diameter, involving the right lung pper lobe. The mass was excised in its entirety, and a biopsy of the mass vas taken and sent for frozen section. The frozen section revealed quamous cell carcinoma. Nodes were then dissected around the pulmonary artery and the trachea. The nodes were sent for frozen section. The nodes were identified as negative per pathology. Saline was irrigated into the chest. It was noted that the liver and diaphragm appeared to be normal with

no lesions seen. After verification that the sponge count was correct, chest tubes were placed for drainage. The surgical wound was closed in layers with chromic catgut and nylon. The patient tolerated this portion of the procedure well The patient was then placed in the supine position for the bronchoscopy.

The patient was still under anesthesia. A flexible fiberoptic bronchoscope was inserted. Patient bronchi were noted bilaterally. The scope was withdrawn. The patient was awakened and sent to the recovery area in stable condition.

a. Bronchoscopy

b. Lobectomy

c. Excision

d. Biopsy

StewartRenee

PRN0098C Lecture Notes - Lecture 3: Aortic Aneurysm, Mammaplasty, Plastic Surgery

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