Procedural Guide For Surgical Exploration cases

- اعداد

دليل الأقسام الداخلية

تحت اشراف

-        أ.د/ محمد لطيف   الرئيس التنفيذي للمجلس الصحي المصري     - د/ كوثر محمود نقيب عام التمريض المصري – عضو مجلس الشيوخ

اعداد

- Professional oath

"I swear by Almighty God That I will be faithful in my work, fear God in my profession, respect its laws and regulations, and perform my duties with efficiency and sincerity. I will rely on the knowledge derived from nursing sciences in my performance. I will do my utmost to care for all those entrusted to me, preserving their dignity, keeping their secrets, defending their rights, and protecting them from harm. I will not fear to speak the truth, even if it means facing criticism, and I will ensure a safe environment for the patient, family, and society. I will continue to develop myself, respect those who have taught me, and cooperate with my colleagues in the profession on the basis of virtue and piety. And I swear by God what I say is true."

Vision – Mission of Nursing Care

Vision of Nursing Care in the Internal Care Unit

- Definition

Exploratory surgery is a type of surgical procedure performed to diagnose or assess a medical condition that has not been clearly identified through other tests. The goal of this surgery is to open a body cavity or specific area for direct examination to determine the possible cause of symptoms or health problems. Exploratory surgery is performed to identify the precise cause of an unclear medical condition or undiagnosed condition after non-surgical tests. During this procedure, the affected body cavity or organ is opened to examine it directly, confirm the presence of any disease or injury, and then take necessary steps for treatment or symptom relief.

- Causes of Exploratory Surgery

1. Diagnosis of Uncertain Conditions:
• Unclear Symptoms: When symptoms are unclear and not resolved by non-surgical tests like X-rays, MRI, or CT scans.
• Early Cancer Diagnosis: To determine the presence of cancerous tumors or assess their spread.
2. Unclear Internal Injuries:
• Injuries from Accidents: When injuries to the abdominal or chest cavity occur, and it's difficult to determine the extent of damage using only imaging tests.
3. Complications After Surgery:
• Postoperative Issues: When bleeding, infection, or obstruction occurs after a previous surgery and the cause is difficult to identify without direct surgical intervention.
4. Failure of Non-Surgical Treatments:
• Ineffective Non-Surgical Treatment: When medications or other treatments fail to alleviate symptoms or resolve the problem.
5. Identifying Causes of Symptoms:
• Chronic or Recurring Symptoms: Such as abdominal pain or internal organ issues that do not respond to conventional tests.
6. Assessing Disease Progression:
• Monitoring Disease Development: Such as infections or damaged tissues to evaluate disease progression and plan for further treatment.

This section provides a foundational understanding of the reasons behind exploratory surgery, its role in diagnosing and treating unclear conditions, and how nursing staff contribute to the patient's care before, during, and after the procedure. 

Exploratory Surgery: Surgical Exploration and Nursing Care

Exploratory surgery is typically performed as an emergency procedure or as part of a directed treatment plan following other diagnostic tests. During this procedure, the targeted organ or cavity is examined directly, and any issues discovered are treated simultaneously if possible.

- Nursing's Vital Role in Comprehensive Care and Support Before, During, and After Surgery

1. Before the Surgery

• Patient Preparation:
• Preoperative Assessment: Perform a comprehensive assessment of the patient's condition, including vital signs, medical history, and current medications.
• Education and Information: Explain the surgical procedure to the patient and their family, including the purpose of the exploratory surgery, what to expect post-surgery, and preoperative preparation steps.
• Physical Preparation: Ensure the patient is properly prepared, such as fasting before surgery if necessary, performing any necessary preparations (e.g., cleaning the skin or inserting a catheter).
• Preparation of the Surgical Environment:
• Surgical Equipment Setup: Ensure all necessary tools and equipment are available, sterile, and ready for use.
• Safety in the Environment: Ensure the operating room or exploration area is free from contamination and that all health protocols are being followed.

2. During the Surgery

• Supporting the Surgical Team:
• Assisting in the Procedure: Provide support to the surgical team during the procedure, such as offering necessary tools and ensuring accurate documentation of each phase of the surgery.
• Monitoring the Patient's Condition: Continuously monitor the patient’s vital signs, anesthesia levels, and ensure the patient’s stability during surgery.
• Fluid and Medication Management:
• Managing Fluids: Oversee the fluids and medications administered during the procedure, ensuring IV fluids and medications are monitored closely.

3. After the Surgery

• Postoperative Monitoring and Direct Care:
• Vital Signs Monitoring: Regularly monitor the patient's vital signs post-surgery, including blood pressure, pulse rate, respiratory rate, and temperature.
• Wound Assessment: Check the surgical site for any abnormal bleeding or infection signs. Change dressings as necessary and ensure the wound remains clean.
• Pain Management:
• Assessing Pain Levels: Evaluate the patient's pain levels using pain scales and provide pain relief according to the doctor's orders.
• Providing Comfort: Help the patient find a comfortable resting position and offer emotional and psychological support to facilitate healing.
• Education and Home Care:
• Guiding the Patient: Teach the patient and family how to care for the wound, manage medications, and recognize when medical help is necessary.
• Post-Discharge Care Planning: Offer guidance on acceptable activities, schedule follow-up appointments, and ensure the patient understands home care instructions.
• Monitoring for Complications:
• Identifying Warning Signs: Keep an eye out for signs of complications such as infections, fluid accumulation, or breathing difficulties.
• Reporting Issues: Immediately report any noticeable changes in the patient’s condition to the medical team.

Effective nursing care in exploratory surgery ensures the provision of comprehensive care, facilitates faster recovery, and minimizes the risks and complications associated with surgical procedures.

- References

• Surgical Nursing: Principles and Practice by Patricia Potter and Anne Perry
• Fundamentals of Nursing: A Nursing Process Approach by Carol Taylor and Lynn Lillis
• Perioperative Nursing: Principles and Practice by Kathleen M. Delaney