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455TREATMENTS

Encourage the patient to maintain the prescribed semibland diet

until his bowel has healed completely (usually 4 to 8 weeks after

surgery). Stress the need to avoid carbonated beverages and gas-

producing foods.

Because extensive bowel resection may interfere with the pa-tients ability to absorb nutrients, emphasize the importance of

taking prescribed vitamin supplements.

AppendectomyWith rare exception, the only effective treatment for acute appen-

dicitis is to remove the inflamed vermiform appendix. A common

emergency surgery, an appendectomy aims to prevent imminent

rupture or perforation of the appendix. When completed before

these complications occur, an appendectomy is usually effective

and uneventful. A perforated appendix carries a greater risk of

mortality. If the appendix ruptures or perforates before surgery, its

infected contents spill into the peritoneal cavity, possibly causing

peritonitis. Most appendectomies are now done laparoscopically,

except in cases where rupture is suspected.

Patient preparationBefore surgery, implement these measures:

Reduce the patients pain by placing him in Fowlers position.

Avoid giving analgesics, which can mask the pain that heralds

rupture.

Risking ruptureNever apply heat to the abdomen, give cathartics or enemas, or

palpate the abdomen; these measures could trigger rupture.

Monitoring and aftercareFollow these steps after surgery:

Carefully monitor vital signs and record intake and output for

2 days after surgery.

Auscultate the abdomen for bowel sounds, which signal the re-

turn of peristalsis.

Regularly check the wound dressing for drainage, and change it

as necessary. If abdominal drains are in place, check and record

the amount and nature of drainage, and maintain drain patency.

Check drainage from the NG tube, and irrigate as needed.

Encourage ambulation within 12 hours after surgery if possible.

Assist the patient as needed.

An appendectomyis commonly an

emergency

procedure, and itsvirtually the onlyeffective treatment

for acuteappendicitis.

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456GASTROINTESTINAL DISORDERS

Encourage coughing, deep breathing, use of an incentive

spirometer, and frequent position changes to prevent pulmonary

complications.

On the day after surgery, remove the NG tube and gradually

resume oral foods and fluids as ordered.Assess the patient closely for signs of peritonitis. Watch for

and report continuing pain and fever, excessive wound drainage,

hypotension, tachycardia, pallor, weakness, and other signs of

infection and fluid and electrolyte loss. If peritonitis develops,

expect to assist with emergency treatment, including GI intuba-

tion, parenteral fluid and electrolyte replacement, and antibiotic

therapy.

Home care instructionsProvide these instructions to the patient:

Tell the patient to watch for and immediately report fever,chills, diaphoresis, nausea, vomiting, or abdominal pain and ten-

derness.

Instruct the patient to avoid strenuous activity (heavy lifting,

stooping, and pushing or pulling) for up to 1 month following sur-

gery.

Encourage the patient to keep scheduled follow-up appoint-

ments to monitor healing and diagnose complications.

Gallbladder surgeryWhen gallbladder and biliary disorders fail to respond to drugs,

diet therapy, and supportive treatments, surgery may be required

to restore biliary flow from the liver to the small intestine. Gall-

bladder removal, or cholecystectomy, restores biliary flow in

gallstone disease (cholecystitis or cholelithiasis) and relieves

symptoms. Its one of the most commonly performed surgeries.

Conventional cholecystectomy requires an incision several inches

long, produces considerable discomfort, and results in weeks of

recovery time.

Laparoscope to the rescueLaparoscopic laser cholecystectomy allows gallbladder removal

without major abdominal surgery. This speeds recovery andreduces the risk of such complications as infection and hernia-

tion. Patients are usually discharged from the hospital and can

resume a normal diet after 24 to 36 hours. Typically, patients can

return to the workplace within 10 days. Laparoscopic laser chole-

cystectomy is contraindicated in pregnancy, acute cholangitis,

septic peritonitis, and severe bleeding disorders. (See Under-

standing cholecystectomy.)

Laparoscopic lasercholecystectomy

speeds recovery and

allows patients toresume a normal diet

after 24 to36 hours.