The Ladd's Procedure for Correction of Intestinal Malrotation ... - AORN

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Ingoe — Lange FEBRUARY 2007, VOL 85, NO 2 least suspicious for intestinal malrotation. A volvulus may be seen as a thin line of contrast in a portion of intestine that is abnormally positioned. Either finding should generate an immediate referral to a pediatric surgeon. Plain x-rays, ultrasounds, and CT scans are not as reliable as a UGI series because the UGI uses contrast media that lights up on the scan. The contrast either stops flowing or only moves through a thin opening. A contrast BE may be performed for evaluation of cecal position if the cause of the obstruction still cannot be determined after a UGI series is performed. 4 A BE is more reliable than x-rays, ultrasounds, and CT scans but is not as reliable as a UGI series because the barium only flows up a certain distance, whereas the contrast in a UGI follows the intestines all the way down. The area above the obstruction would not be visualized during a BE. PREOPERATIVE PREPARATION When the OR is being prepared for a pediatric procedure, the circulating nurse turns up the room temperature to between 75° F and 85º F (23.9º C and 46º C) depending on the surgeon’s preference. The circulating nurse places a pediatric, underbody, forced-air, temperatureregulating blanket on the bed 8 and obtains an IV-solution warmer and irrigation fluid warmer. The circulating nurse ensures that the pediatric emergency anesthesia cart is in the room. PREOPERATIVE CARE OF THE PATIENT. After the infant has been admitted to the preoperative holding unit, the circulating nurse greets the patient and his or her parents and confirms the patient’s identity using at least two identifiers (eg, the identification band, medical record, parent’s confirmation). After reviewing the patient’s medical record, the nurse ensures that the patient’s laboratory, radiology, and gastrointestinal test results are on the chart and verifies that the surgical consent is accurate according to the patient’s records, OR schedule, and parents. The nurse verifies the patient’s allergies and NPO status with the parents and medical record. The nurse then performs an assessment that includes the patient’s vital signs, nutritional status, skin turgor, and skin pallor. The nurse then develops a care plan specific for this patient undergoing the Ladd’s procedure (Table 1). CARING FOR THE PARENTS BE- FORE SURGERY. This surgery usually is performed on an emergency basis, so the infant’s parents may be emotionally distraught. The circulating nurse can take numerous actions to help alleviate some of the parents’ fear. If possible, the circulating nurse should sit down with the parents and introduce himself or herself. The nurse should explain exactly what the role of the circulating nurse is in taking care of their child and explain the role of each perioperative team member, including ancillary personnel. The nurse should speak in a soft, calm, and reassuring tone and should not speak rapidly. He or she should give the parents time to ask questions and to contemplate what he or she is telling them. To instill trust, the nurse should make eye contact with each parent and use touch when appropriate. The nurse should ensure that all of the parents’ questions have been answered and that they understand the procedure completely. The nurse should reassure the parents that he or she will call the waiting room periodically to give The circulating nurse can take numerous actions to help alleviate the parents’ fear, such as speaking in a reassuring voice and explaining the role of the circulating nurse in taking care of their child. AORN JOURNAL • 303
FEBRUARY 2007, VOL 85, NO 2 Ingoe — Lange TABLE 1 Nursing Care Plan for Pediatric Patients Undergoing the Ladd’s Procedure Diagnosis Risk for compromised family coping related to the stress of surgery Risk of hypothermia related to perioperative environment, patient age, and exposed body surfaces Risk for infection related to immature immune system and poor nutritional status 304 • AORN JOURNAL Nursing interventions • Identifies communication barriers and knowledge level. • Assesses readiness to learn. • Elicits family members’ perception of anesthesia and surgery. • Uses appropriate communication skills to ease fears and improve comprehension of patient and family members, such as • sitting with family member when performing patient education, • making eye contact with each parent, • speaking slowly and clearly and observing for indications of confusion versus comprehension, and • allowing time for questions and answers. • Ensures parental presence during anesthesia induction, if desired and permitted by facility policy. • Evaluates family members’ response to instruction. • Monitors body temperature throughout the perioperative period. • Implements thermoregulation measures, including • heating the OR to between 75° F and 85º F (23.9º C and 46º C); • placing a pediatric, underbody, forcedair, temperature-regulating blanket on the OR bed under the patient; • placing a stocking cap on the infant’s head; • using IV and irrigation solution warmers according to manufacturer instructions; and • wrapping the infant’s extremities with cotton cast padding to help minimize skin exposure as much as possible. • Evaluates response to thermoregulation measures. • Assesses skin integrity, sensory impairments, and gastrointestinal status. • Observes sterile field and perioperative team members to ensure that asepsis is maintained. • Validates that preoperative antibiotic was administered according to facility policy. • Allows sufficient time for surgical prep solution to dry before the patient is draped. Interim outcome criteria Patient’s family members • verbalize understanding of the procedure, sequence of events, and expectedoutcomes and • demonstrate the ability to cope throughout the perioperative period. Parents and patient demonstrate appropriate bonding. Patient’s core body temperature remains in expected range throughout the perioperative experience. Patient’s wound is dry, nonreddened, and non-tender. Patient does not demonstrate symptoms of infection (eg, wound induration, foul odor, purulent drainage, fever) Outcome statement Patient’s family members demonstrate knowledge of the physiological and psychological responses to the procedure. Patient is at or returning to normothermia at the conclusion of the immediatepostoperative period. Patient is free of signs and symptoms of infection through the 30 days after the perioperative procedure.
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