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

Ingoe — Lange FEBRUARY 2007, VOL 85, NO 2
postoperative needs of the patient. The
circulating nurse calls the pediatric
surgical unit nurse or PICU nurse during
wound closure to communicate
these needs. This gives the receiving
nurse time to prepare the room for the
patient. The circulating nurse’s report
includes
• the type and length of procedure that
was performed,
• the amount and type of narcotics administered
during the procedure,
• the antibiotics received before and
during the procedure,
• the total amount of IV fluids administered
intraoperatively,
• the blood or blood products administered
during surgery,
• whether the patient will be extubated,
and
• the patient’s temperature during
the procedure and a current end-ofprocedure
temperature.
More information may be provided depending
on specific unit policies and patient
circumstances. The nurse also ensures
that extra support staff members
are available to assist with transporting
the patient.
ENSURING POSTOPERATIVE NORMOTHERMIA. A
child’s body temperature can drop
very quickly, particularly during extubation
or transport to the postoperative
unit. The nurse ensures that the
patient is kept warm during this time.
If the child will be transported in a
crib, the circulating nurse lines the bed
of the crib with warm blankets immediately
before placing the patient in the
crib and keeps the patient securely
wrapped in a warm blanket, papoosestyle,
as much as possible. The circulating
nurse also places a rolled blanket
behind the patient’s back to keep
the patient on his or her side to prevent
aspiration if vomiting occurs.
AVOIDING POSTOPERATIVE HYPOXIA. The circulating
nurse ensures that a full oxygen
tank is on the transport vehicle (ie, crib,
bed) and easily accessible. After moving
the patient from the OR bed to the transport
vehicle, the circulating nurse attaches
one end of the oxygen tubing to
the tank and holds or tapes the other
end close to the patient’s mouth and
nose so that the oxygen is blowing by
the patient. This is much like using a
nasal cannula for an older patient. This
method of administering supplemental
oxygen is continued
until the patient’s oxy-
gen saturation level consistently
remains within
normal limits.
If the anesthesia care
provider does not extubate
the patient, the circulating
nurse ensures
the availability of a selfinflating,
bag-valve-mask
resuscitator for transport.
The circulating nurse obtains
a portable cardiac
monitor to monitor the
patient’s condition during
transport to the postoperative
recovery unit.
PROVIDING POSTOPERATIVE
NUTRITION. Infants who undergo
extensive intestinal
resections often are not
able to tolerate enteral nutrition for
quite some time. If that is the situation,
total parenteral nutrition (TPN) will be
started and continued long term. Children
on long-term TPN will be monitored
for chronic liver damage, a risk of
long-term TPN. 2
PROGNOSIS
If intestinal malrotation with volvulus
is recognized and treated quickly,
the patient should recover well and
not have any long-lasting effects, providing
there is enough bowel left
to sustain life. Children who have undergone
this procedure most often
progress through life with little or no
Supplemental
oxygen is
administered
until the
patient’s oxygen
saturation level
consistently
remains within
normal limits.
AORN JOURNAL • 307