Surgical Robots And The Field Of Surgery

Surgical Robots And The Field Of Surgery
Surgical Robots in the Field of Surgery Shenin Siddiqui Monmouth University Surgical Robots in
the Field of Surgery Technology is advancing each and everyday. In the medical field and especially
in the field of surgery, the most popular topic is robotic surgery. Robotic surgery is a novel and an
exhilarating advancement in the medical field. Currently, surgical robots mainly have a promotional
role rather than a practical role. However, robots are being used in many small surgeries and the
extent of robots in the medical world is still evolving (Lanfranco, Castellanos, Desai, & Meyers,
2004). To genuinely understand this futuristic technology, the advantages, the disadvantages, the
current and the ... Show more content on Helpwriting.net ...
Throughout an operation, the robots make instrument handling more natural. Furthermore, with the
help of surgical robots, doctors can avoid unnecessary movements to change tools and to look at the
monitor (Lanfranco, Castellanos, Desai, & Meyers, 2004). This is beneficial because this allows the
surgeon to solely focus on the surgery and to get the job done more quickly and efficiently.
Moreover, the three dimensional sight from the robot is much more clear compared to the usual
laparoscopic camera. All these advantages of robotic surgery tremendously help surgeons with
identifying and dissecting body parts (Lanfranco, Castellanos, Desai, & Meyers, 2004). Therefore,
this advanced technology can make surgeries more effective and less difficult. Although surgical
robots are beneficial, there are a few disadvantages to this innovative technology. To begin, robots in
surgery are fairly new and their effectiveness is not fully recognized (Lanfranco, Castellanos, Desai,
& Meyers, 2004). Thus, surgical robots are not altogether reliable. Also, the expense of surgical
robots is a major disadvantage because surgical robots can cost millions of dollars. There is a
possibility that the price of the robots may drop in the future with more developments in technology
and with more practice with robots. On the other hand, many believe that the price of the robots will
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Cholelithiasis Research Paper
Cholelithiasis also knows as gallstones occurs in the gallbladder, the function of the gallbladder is to
store and concentrate bile. Cholelithiasis occurs when the balance that keeps cholesterol, calcium,
bile salts solution is altered. The bile secreted by the liver is supersaturated with cholesterol
therefore it come out as a solid. Immobility, pregnancy and inflammation or obstructive lesions of
the biliary system decreases bile flow. The stones may stay in the gallbladder or move to the cystic
duct or the common bile duct. The main clinical manifestations would be severe pain. The pain can
be so severe that is can cause diaphoresis and tachycardia, when the pain slows down the patients
may notice a residual tenderness in the right upper

Case Analysis : Laparoscopic Cholecystectomy
The case overview states that the patient was referred to Dr. Freeman for a consult because of
complications with gallstones.
The case never once stated that the doctor ran any type of test to show or prove the referring
physician's diagnosis that the patient was actually suffering from gallstones. The physician neglected
to question the patient as to where she was experiencing pain or anything. Instead it states that his
diagnosis for the patient was to undergo a surgical procedure known as laser laparoscopic
cholecystectomy. This type of procedure is commonly done when patients complain about pain in
the upper part of their abdomen. Much concern for the welfare of the patient comes to mind because
of the lack of test that were done to detect that this was the case only the word of the physician.
It never once mentioned what type of physician he was or his qualifications for performing this
minimal invasive type of procedure. Instead I guess the patient stated to her main doctor about the
pain she was experiencing and he referred her to another physician. This article will give emphasis
on two main questions that have come to mind such as: Are there credentialing issues with the
physician? Also, what steps should the hospital have taken to help ensure that the physician was
qualified to perform this type of procedure.
Credentials of Physician to perform this type of surgical procedure
There are exactly 10 fire reasons that there can be a roadblock when a physician is

Taking a Look at Cardiovascular Disorders
Cardiovascular Disorders A 60–year–old male, 5 days post laparoscopic cholecystectomy, is getting
ready to be discharged today and is going through the final assessment. When the assessment takes
place, the nurse finds that patient has a pulse of a 110 beats per minute and irregular compared to his
normal 86–90 beats per minute with a regular pulse that the patient has been having since post–
surgery.
Pulse
Since post–surgery, there has been an increase in patient's pulse rate to110 beats/minute and the
pulse is now irregular. This fact should raise a red flag. This finding would be documented after the
nurse retakes the pulse to make sure that there was not an error. The nurse should call the physician
immediately to inform him/her of the findings and get further instruction as to how to proceed with
patient care.
Significance of an irregular pulse
The irregular pulse can show problems with the heart and its functions. It can be a sign of heart
disease such as dysrhythmia. "Some dysrhythmias may be asymptomatic while others can cause
death. The danger and symptoms depend on the extent that they reduce cardiac output." (Story,
2012)
Assessment for post laparoscopic cholecystectomy.
The key components for a patient with five days post laparoscopic cholecystectomy is to do a
physical assessment, monitor the patient's vital signs and look for any abnormalities such as high
fever, pain, abnormal heart rate, high blood pressure. Bowel movements have to be monitored to
make

Argumentative Essay: The Dangers Of Animal Experimentation
Animal experimentation today is much different than it was 100 years ago, it is still changing today,
and will continue to change forever. Keeping to a moral high ground is difficult if a milestone is
close to becoming met, people get greedy or overly ambitious. Pushing aside ethics to achieve a
result is a very common and many times it has been beneficial for the greater good. Drawing a line
for professionals to not cross is the best thing to protect the rights of individuals and animals. Many
experiments go on across the world that increase the well being of humans, some impact humanity
more than others. People need to develop a moral compass to keep animal experimentation humane,
laws are a perfect example for guiding research.
Laws have ... Show more content on Helpwriting.net ...
Goland writes "preventing {Peripartum Cardiomyopathy} PPCM in mice by prolactin inhibition
with bromocriptine, early experience of its use in patients with PPCM in South Africa and Germany
has been reported with promising results." (Goland, 2015) the test involves taking sick animals and
treating them with bromocriptine to reduce the prolactin levels thus preventing PPCM. The drug is
first being tested on mice because the outcome of the experiment was theorized to be a good
outcome. Today we know much more about how we will test drugs before we feed it to animals.
Early scientist used trial and error testing to find their results, that is inefficient and time consuming,
which ends with varying results. Before researchers feed mice a drug there is an expected outcome
and many times the theory are close to the experimentation outcome. Analyzing outcome gives us an
idea on if an experiment is ethical or not, we can say the test subjects will be hurt too much for a
poor outcome. In this case pregnant women are gaining a cure for PPCM and mice are also, WIN

Surgical Team Essay
A surgical team is a 'treatment team', tends to be ongoing and relatively permanent in nature, which
consists of a collection of individuals who are independent in their tasks (known as formal group),
such as; surgeon, anaesthesiologist, sometimes medical staff (depending on surgery), certified
registered nurse anaesthetist (CRNA), operating nurses, surgical technician. Poor teamwork and
inadequate communication are donating to the lack of improvement in the number of patients in
healthcare sector. When I was an intern in surgical department, I had experienced number of patients
were died within few days after medical/surgical intervention. Among them more than fifty percent
who died were emergency admissions, who often failed to be fully evaluated for other medical
problems before intervention. As there were inadequate medical information about emergency
admitted patients, sometimes anaesthesiologists were made medication error at some stage ... Show
more content on Helpwriting.net ...
Learning: To detection and correction of error, ability to learn is essential for ongoing team
effectiveness. As medical knowledge is constantly developing and keep up with new care protocols,
medication and technology can save procedure time and patient's life. For example: laparoscopic
cholecystectomy (new technology for removal of gall bladder) is less invasive and less time
consuming produce than abdominal cholecystectomy. 2. Team characteristics– As there is 'status
difference' in a surgical team, sometimes team members feel a sense of role deprivation. Resulting
professional conflict, poor 'team cohesiveness' and team members do not share 'team norms'
properly. Action plan as a team leader: I would Take decision alone as time is critical in emergency
and decision must be made quickly. Then I would arrange a quick meeting with the other team
members (about the goal and action plan) before any

Perioperative Observation Experience. I Observed A...
Perioperative Observation Experience
I observed a laparoscopic cholecystectomy at Sentara Albemarle Medical Center. In this paper, I will
cover pre–operative tasks, surgical procedure, anesthesia and interventions, roles and functions of
the nurse, and surgical team members. I will also cover safety and comfort concerns along with
nursing diagnoses related to this surgery.
Pre–Operative Data Collection and Medications
Pre–operative data collection was obtained in the ambulatory minor surgery unit (AMSU). A
communication sheet was filled out that collects patient data such as their diagnosis, the procedure
they are having, drug allergies, vital signs, IV placement, and their current medications. This
information is documented by the AMSU ... Show more content on Helpwriting.net ...
Propofol was administered to put the patient to sleep initially. The patient was kept asleep with
anesthesia gases. These gases are fluorinated ethers combined with nitrous oxide. A paralytic was
also administered to keep the patient's muscles from moving during the procedure. During the
procedure, the CRNA monitored the patient's vitals, especially the blood pressure. The blood
pressure decreases prior to the initial incision and will increase after the cut is made. The CRNA was
monitoring that the patient's blood pressure did not get too low before the incision was made. The
CRNA also made sure the patient was positioned to prevent injury such as pulled muscles and
pinched nerves.
Roles and Functions of the Nurse The AMSU, or pre–operative nurse, is responsible for the pre–
operative assessment. In this assessment, the nurse obtains vitals, receives a health history, and
documents current medications the patient is taking. In the OR, the nurse is a circulating nurse. The
nurse operates outside of the sterile field. They are responsible for charting information during the
surgery and ensuring safety precautions are in place. The circulating nurse is responsible for
collaborating with all other surgical team members. In the post–anesthesia care unit (PACU), the
nurse is responsible for assessing the patient's condition by taking and recording vital signs. The
PACU nurse also helps rouse the patient still recovering from anesthesia and is responsible for
reacting

Appendectomy Essay
similar for obese patients with perforated appendix, with the laparoscopic approach demonstrating a
superior outcome. Mason et al. [31] corroborated these findings using data from the American
College of Surgeons National Surgical Quality Improvement (NSQIP) Program database. In a
sample of 13, 330 obese patients with a body mass index >=30 kg/m2 who underwent
appendectomy between 2005 and 2009, they showed that laparoscopic appendectomy was
associated with a 57% reduction in overall morbidity in all obese patients, and a 53% morbidity
reduction after a 1:1 matching to reduce bias. After matching, laparoscopic appendectomy showed a
reduction in length of stay by 1.2 days compared to open. A review of the NSQIP database by
Tuggle et al. ... Show more content on Helpwriting.net ...
Kiviluoto et al. [34] randomized 63 patients with acute cholecystitis and similar demographic,
physical and clinical characteristic to receive either LC or OC. They found a significantly lower
postoperative complication rate, shorter postoperative hospital stay and lower mean length of stay in
the LC group. El–Awadi et al. [35], in a randomized controlled study, evaluated 110 cirrhotic
patients with symptomatic cholelithiasis. They demonstrated a longer operative time (96.13 vs.
76.13 minutes, p<0.01) and higher postoperative morbidity in the OC group compared to LC. Ji et
al.[36] performed an RCT in 80 patients with symptomatic gallbladder disease and portal
hypertension from cirrhosis in a bid to compare LC vs. OC. LC demonstrated superior outcomes
over OC with lower intra–operative blood loss, shorter time to resume diet, fewer post–operative
complications and shorter length of hospital stay. In terms of costs, multiple studies have
demonstrated a net cost–effectiveness profile that favors laparoscopic cholecystectomy, with some
others showing equivalent costs. While initial studies demonstrated a higher operating room costs
for LC, these were offset by lower overall hospital costs due to shorter hospital length of stay.
McIntyre et al. [37] reported a mean hospital charge of $6471 for LC vs. $8896 for OC. As with
laparoscopic appendectomy, there are still clear

Cholecystitis
Gallstones
Cholecystitis
Cholecystitis is inflammation of the gallbladder. Inflammation usually forms when a gallstone
blocks the cystic duct that transports bile. Cholecystitis is the most common problem resulting from
gallbladder stones (90% of the cases). Cholecystitis affects women more often than men and is more
likely to occur after age 40. People who have a history of gallstones are at increased risk for
cholecystitis. Cholecystitis has an increased prevalence among people of Scandinavian descent,
Pima Indians, and Hispanic populations. It affected 20 million people with a mortality record of
1,092 deaths in 2004. Hospitalizations total up 622,000 in the same year and over 700,000 have
undergone cholecystectomies. ... Show more content on Helpwriting.net ...
Pain can last anywhere between several minutes to several hours. Warning signs are abdominal pain
so intense that you can't sit still or find a comfortable position, yellowing of your skin and the whites
of your eyes, clay colored stool and high fever with chills. Complications that can occur from
gallstones if left untreated are inflammation of the gallbladder (cholecystitis), blockage of pancreatic
duct (gallstone pancreatitis), rupturing of the gallbladder, peritonitis, liver damage, cirrhosis and
gallbladder cancer.
When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound
exam or CT Scan, the most sensitive and specific test for gallstones. Other exams that may be
performed are a Cholescintigraphy a.k.a. HIDA (hepatobiliary iminodiactec acid) Scan, ERCP
(endoscopic retrograde cholangiopancreatography), and blood tests. Treatments include Surgery and
medications to dissolve the gallstones. Nearly all cholecystectomies are performed with
laparoscopy. If tests show the gallbladder has severe inflammation, infection, or scarring from other
operations, the surgeon may perform open surgery to remove the gallbladder. In some cases, open
surgery is planned; however, sometimes these problems are discovered during the laparoscopy and
the surgeon must make a larger incision. If gallstones

Cholelithiasis, are the reaming's of the digestive fluid bile, which form within the gallbladder. They
vary in size and shape from as small as a grain of sand to as large as a golf ball.[1] Cholelithiasis
occur when there is an imbalance in the chemical constituents of bile that result in precipitation of
one or more of the components. Gallstone disease is often thought to be a major affliction in modern
society.[2] However, cholelithiasis must have been known to humans for many years, since they
have been found in the gallbladders of Egyptian mummies dating back to 1000 BC.[3,4] This
disease is however, a worldwide medical problem, even though there are geographical variations in
gallstone prevalence[5,6,7,8,9,10,11] Cholelithiasis are becoming increasingly common. They are
seen in all age groups, but the incidence increases with age.[12] About a quarter of women over 60
years will develop them.[13] In mostbcases they do not ... Show more content on Helpwriting.net ...
In Pakistan and in Western societies more than seventy percent of cholelithiasis are made of
cholesterol, either pure or mixed with pigment, mucoglycoprotein, and calcium carbonate. Pure
cholesterol crystals are soft, and protein gives strength of cholesterol stones. Cholesterol
cholelithiasis form when the cholesterol concentration in bile surpasses the capability of bile to hold
it in

Acute Cholecystitis
Acute cholecystitis is the acute inflammation of the gall bladder, which is most commonly caused
by gall stones [1]. Gall stones affect about 10% of the western population [2]. Asymptomatic gall
stones are present in more than 80% of the patients and among the patients of symptomatic gall
stones only 1–3% develop acute cholecystitis [1], [3]. Hence acute cholecystitis is considered the
most common severe complication of gall stones [3]. Ascariasis– a major cause of biliary disease
also results in acute cholecystitis b/c the cystic duct obstruction caused by the helminth causes an
inflammatory process to start [4]. Acute cholecystitis is diagnosed on the basis of clinical features
and ultrasonography [1]. Literature gives two opinions regarding the surgical treatment of acute
cholecystitis– first is the early surgery within few days ... Show more content on Helpwriting.net ...
Clinical diagnosis to differentiate between complicated (empyema/gangrene) and uncomplicated
acute cholecystitis is difficult because the clinical features are the same such as biliary cholic [10],
and only one–third of gangrenous gall bladder patients show positive murphy's sign probably due to
necrotic denervation [11]. Empyema and gangrene can further cause complications such as biliary
peritonitis, fistula, and intra peritoneal abscess formation [12], [13], [14]. Higher morbidity is
associated with laproscopic cholecystectomy of gangrenous and empyematous gall bladder, so
prevent this complication early cholecystectomy should be performed [15]. But because of limited
resources it is not possible for every case to be operated early hence preoperatively there is a need to
identify the risk and prioritize patients for surgery according to the risk of developing complication

Minimally Invasive Procedure Essay
BRIEF OVERVIEW OF MINIMALLY INVASIVE PROCEDURES
Minimally invasive surgery or keyhole surgery are operation techniques that uses a limited number
of cannulas which are inserted through small incisions in the skin on the body of the patient. The
method allows the access of thin firm instruments to treat tissues internally. In addition, a small
camera is also inserted through one of the cannulas in order to have a better observation of the
activities inside the body of the patient.
Minimally invasive procedures are done on the patient's abdomen, blood vessels, chest, uterus,
joints, and gastrointestinal tract.
KEY ISSUES ASSOCITED WITH DELIVERING SURGICAL PATIENT CARE UNDER
MINIMALLY INVASIVE PROCEDURES.
The access point of minimally invasive ... Show more content on Helpwriting.net ...
X., & Su, M. (2010). Carbon dioxide pneumoperitoneum, physiologic changes and anaesthetic
concerns, it states "there are different mechanism involved the decreased urinary output during IAP.
Shuto et al. showed that by compressing the renal vessels and parenchyma of the IAP of 20 mmHg
can cause a decrease in renal blood flow significantly. Also, RAAS is activated by the IAP, thereby
resulting to renal cortical vasoconstriction. Chui et al reported a decrease of 60% in renal cortical
flow, which however returned to normal after disinflation. Otega et al reported a precipitous rise in
ADH concentration during laparoscopic cholecystectomy, which was not seen in open
cholecystectomy. The exact mechanism of renal blood flow disturbance by pneumoperitoneum is
still to be concluded, although volume status may play a major role. Renal blood flow has been
measured during increasing IAP, and a gradual decrease in RBF up to 75% was observed upon
reaching a pressure of 15 mmHg.
Gastrointestinal Effects
Due to the increase in intra–abdominal pressure, contents of the stomach have the tendency to
regurgitate and there is a risk for pulmonary aspiration. This happens to patients who are obese.
Neurological Effects
Intracranial pressure (ICP) is increased by the escalation in IAP and as a result there is decrease in
cerebral perfusion pressure especially if there is decrease in cardiac output.
Roles of patient positioning
Positioning patients during laparoscopic

Laparoscopic Cholecystectomy
Abstract
Background: Laparoscopic cholecystectomy has rapidly become the preferred procedure for gall
stone disease so that different studies were done to evaluate different strategies in management and
outcome to reach guidelines in laparoscopic operation and to compare it with its open. Controversial
significance of irrigation during laparoscopic cholecystectomy is still present .
Aim of study :
We conducted a prospective study to evaluate the significance of 0.9% normal saline irrigation after
conclusion of laparoscopic cholecystectomy which might be of value in future of the world of
laparoscopic cholecystectomy. Patients and methods: Study group of ninety nine patients were
analyzed in prospective study; Forty seven ... Show more content on Helpwriting.net ...
Normal saline irrigation carries a lot of advantages of being haemostatic , activates procoagulant
state , is not significantly different as irrigation fluid from antibiotic solution11and encourages
acidotic environment of carbonic acid field made from CO2 pneumoperitoneum which might
explain some factors in laparoscopic as compared with open operations as mild antiseptic
environment of CO2 pneumoperitoneum might decrease the infections risk slightly as well the
irrigation may reduce the postoperative shoulder tip pain which is caused by CO2 irritation of
diaphragm12,13 .
Initial use of ultrasonography in diagnosis of intra–abdominal collections was found to have several
advantages and disadvantages. The accuracy of ultrasonography in diagnosis of intra–abdominal
collection was found to be 97% with sensitivity of 93% and a specificity of 99% 14.
Subhepatic space collection was reported as complication of cholecystectomy and true incidence
and clinical significance of organ space collection and influence on these , if any , of normal saline
irrigation during laparoscopic cholecystectomy was

Disadvantages Of Laparoscopy
Introduction
Laparoscopy has revolutionized surgery during the last three decades; however, the roots of
minimally invasive surgery can be traced back much earlier, to ancient times. The first description of
endoscopic procedures came from Hippocrates, who inserted different instruments into various body
orifices, in order to observe anatomy and pathological processes. The first 'celioscopies' were
described in the early 20th century by the German surgeon Kelling, who used a cystoscope inserted
through an abdominal wall incision in dogs to insufflate the abdomen with filtered air. Bernheim
described his experience with
'organoscopies' in his series of 17 live human subjects in 1911.
The major breakthroughs in the field of laparoscopic surgery ... Show more content on
Helpwriting.net ...
Once the surgeon gains sufficient laparoscopic skills, the hand can be left outside the abdominal
cavity and the benefits of laparoscopy can be conferred upon the patient.
Single–incision laparoscopic surgery
Some of the proven major advantages of conventional multiport laparoscopy (CML) over the open
approach are reductions in pain, length of stay, wound complications, and improved cosmesis.
Single–port laparoscopic surgery (SILS) may further enhance the advantages of CML by performing
the entire procedure through a single incision in the abdominal wall, thus minimizing surgical
trauma. SILS represents the next evolutionary step in minimally invasive surgery, towards a totally
scar free procedure; however, in this technique, the laparoscopic working ports are all introduced
through the single incision, which contradicts the basic 'triangulation' rule of laparoscopy.
This method requires advanced laparoscopic skills when compared with CML, added complexity,
and poorer ergonomics, while early studies have also reported a longer operating time than with
CML.
SILS has introduced several new, inherent, technical

Case Study On Acute Pancreatitis
Background: Acute pancreatitis is an inflammatory disease of the pancreas, develops over a short
period of time. Aim: To evaluates the clinical presentation in different age group, gender, aetiology,
mortality, morbidity and outcome of management of patients with acute pancreatitis in surgical unit
of MNR teaching hospital. Material and Methods: A prospective study was conducted in MNR
Medical College Hospital over a period of 3 years. Patient details, clinical examinations, laboratory
reports, treatment options, complications and mortality rate were recorded during study period.
Results: Among 46 patients, 29 (63.04%) were males and 17 (36.95%) were female. Most common
age group with acute pancreatitis was 21–30 years (45.65%). All patients ... Show more content on
Helpwriting.net ...
Major age group with acute pancreatitis was 21–30 years (45.65%). There were significant
differences in age group of patients (at P< 0.05) [Table2]. In our study all patients had pancreatic
oedema. 12 patients (26.08%) had gallstones, 7 patients (15.21%) had pseudo cyst, 8 (17.4%) had
ascities and 7 patients (15.21%) had hepatosplenomegaly [Table3]. There was increase in serum
amylase level in all patients. Hypocalcaemia was found in 7 patients (15.2%). In 11 cases (23.95)
bilirubin level was raised. Prothrombin time was increased in 3 patients (6.5%). In all patients
haemoglobin level was normal. We followed Ranson's criteria to assess the severity and prognosis of
the disease. Cholecystectomy was applied for 19 (41.30%) patients. Other operative procedures such
as, cholecystogastrostomy and necrosectomy was done for 3 (6.52%) and 2 (4.34%) respectively.
There was no need to use any operative procedures for 22 (47.82%) patients [Table4]. 3 patients
(6.5%) were died out of 46

Essay On Acute Calculous Cholecystitis
Patients and methods
The current study completed at the General Surgery department, Banha University Hospital in Egypt
and King Saud Hospital in Saudi Arabia since January 2015 till May 2017. The present study
includes 100 patients with acute calculous cholecystitis. After approval of the study protocol by the
Ethical Committee and obtaining fully informed written patients' consent for the participation in the
study. Patients hospitalized through the emergency unit to the General Surgery department, high
dependency unit (HDU) or intensive care unit (ICU) according to the seriousness of patients' general
condition at the time of admission.
Patients admitted for clinical, laboratory and radiological evaluation. Patients examined ... Show
more content on Helpwriting.net ...
Also, we excluded patients with gallbladder perforation or Mirizzi syndrome (preferred to do open
cholecystectomy), Patients with gallbladder tumors or cholangitis (typically, to be managed
conservatively first), and patients without complete data.
According to Tokyo Guidelines (TG13) [9], the severity assessment of ACC graded, grade I (mild):
AC with mild GB inflammation with no organ dysfunction in a healthy patient, grade II (moderate):
AC with one of the subsequent disorders: WBC count > 18 x109/L, tender mass in the right
hypochondrium, onset of symptoms > 72 h, biliary peritonitis, pericholecystic abscess, liver abscess,
gangrenous GB or emphysematous GB and grade III (Severe): AC associated with dysfunctions in
one of the subsequent systems/organs: Neurological deterioration (diminished level of
consciousness); cardiovascular impairment (hypotension necessitating dopamine 5 µg/kg/m, or any
dose of dobutamine); renal impairment (creatinine > 2.0 mg/dl, oliguria); respiratory failure
(PaO2/FiO2 ratio < 300); bone marrow dysfunction (platelet count < 100 x109/L)and hepatic
function deterioration (INR > 1.5).
Preoperative assessment and preparation
On admission, all patients received intravenous broad spectrum antibiotic as soon as the diagnosis of
ACC was established. When

Lars Case Study Essay
1. My diagnosis for Lars is that he has chronic cholecystitis, which is a type of constant
inflammation of the gallbladder. According to research, the chronic cholecystitis is one of the "most
common biliary diseases" (Sato et al., 2002). With Lars' situation, his rapid weight loss which
decreases the lipids can create an imbalance of bile composition which then increases the chances of
having gallstones in the gallbladder. 2. A theory that would explain the beginning of the patient's
condition is that the chronic inflammation changes the gallbladder wall because of the different
types of gallstones hitting the epithelial tissues which then makes the gallbladder extremely
sensitive. Some patients even experience pain after eating a meal because

Cholecystitis and Perioperative Care Essay
Cholecystitis and Perioperative Care
Cholecystitis is the inflammation of the gallbladder. The gallbladder is a small pear– shaped sac
located on the right underside of the liver. The gallbladder's function is to store digestive bile, which
is continuously produced by the liver. Bile assists in the digestion of fats and absorption of certain
vitamins. A healthy gallbladder empties when fatty foods enter the duodenum to aid in breaking
down large fat particles into smaller ones. In most cases, cholecystitis is caused by a blockage or a
stone in the gallbladder. "About 90 % of cholecystitis is caused by gallstones, often found blocking
the cystic duct" (Baldwin 2008). Bile becomes trapped in the gallbladder and ... Show more content
on Helpwriting.net ...
Cholecystitis symptoms usually occur after a meal that is high in fat content. Other classic signs of
inflammation are low grade fevers, chills and abdominal distention. Studies show that "about 40%
of patients have gallstones that are discovered during testing for other conditions (Baldwin 2008)."
"Gallstones should only be treated if they cause symptoms" (Harvard Women's Health Watch 2011).
Chronic cholecystitis is caused by repeated attacks of acute cholecystitis. This leads to the
thickening of the gallbladder wall and a decrease in motility. Cholecystitis can cause a number of
complications. Gallbladder distention leads to the buildup of bile and cause pain. Once the bile has
built up, it may become infected. Untreated cholecystitis can cause tissue death or perforation.
Infection is a serious complication in cholecystitis. This condition can become life–threatening and
spread to other parts of the body. Diagnosing cholecystitis involves a thorough physical exam and
blood tests. White blood count is usually high, which indicates infection. High bilirubin levels,
alkaline phosphatase and liver enzymes will also increase. Computerized tomography (CT) can be
used to reveal signs of cholecystitis but "ultrasound is considered the primary imaging method for
most gallbladder and ductal disease" (Baldwin 2008). Another test used in confirming a diagnosis
for cholecystitis is a hepatobiliary iminodiacetic acid scan (HIDA).

Galltone Gallbladder Case Study
Diagnosis: creating pictures of the Gallbladder– recommend an abdominal ultrasound and/or a (CT)
computerized tomography scan to produce pictures of your gallbladder. These images are then
analyzed for the signs of gallstones.
Blood test to look for complications: the blood test may reveal jaundice, an infection, pancreatitis or
other complications caused by Gallstone.
The organ system affected: The organ system that the disease Gallstone affects is the digestive
system. Gallstone affects the Gallbladder The test performed to diagnose the disease: the tests that
are preformed to diagnose Gallstone is a, magnetic resonance imaging (MRI), endoscopic retrograde
cholangiopancreatography (ERCP) or hepatobiliary iminodiacetic acid (HIDA) scan.

Surgical Procedures During The Surgical Procedure Essay
I had the pleasure of observing three different surgical procedures during my OR rotation
The first surgical procedure was a caesarean section (C–section), that was done as a repeat because
the patient had her previous children delivered as a c–section and was not able to deliver vaginally. I
also got a chance to observe an umbilical hernia repair. This procedure was performed because part
of the intestines were protruding through the umbilical opening which may have caused pain or
discomfort. The patient had given birth a few months prior to the surgery which may have caused
the protruding intestine. The third surgical procedure I observed was a Laparoscopic gallbladder
removal (cholecystectomy). This procedure was performed because the patient had gall stones
present in the gallbladder.
Negative effects of surgery When a person goes under the knife, he or she open themselves up to
risks that are involved when having surgery that will determine the outcome of the operation. There
are risks of surgical complications, the risk of infection, bleeding uncontrollably and risking your
life by not waking up and getting through the surgical procedure. Patients can be affected
psychologically due to prolonged recovery and long lasting disability if complications occur. This
may cause psychological distress, which can delay recovery as stress delays wound healing and
compromises some immunity. (Pinto, Faiz, Davis, Almoudaris, & Vincent, 2016). Side effects from
the anesthesia used

Gallstones Research Paper
Gallstones are described as digestive fluid that has hardened which can be very painful. They form
in the gallbladder which is a pear shaped organ that is located on the right side of of the abdomen
right underneath the liver. Gallstones can be many sizes which varies how much the pain is. They
can be as small as a crumb to a size of a golf ball! Ouch! Also, some people have more than one,
while other people may just have one. More than likely, you will have symptoms if you have
gallstones and if you do have symptoms, most people have to get gallstone removal surgery. These
symptoms may include, sudden pain in your upper right side of the abdomen or under the breast,
back pain between shoulder blades, right shoulder pain, nausea, or vomiting. ... Show more content
on Helpwriting.net ...
You need to seek immediate care when you are experiencing so much pain you can't sit comfortable,
skin is turning yellow, whitening of eyes, high fever, and chills. There are different types of
gallstones and these types consist of cholesterol gallstones and pigment gallstones. Cholesterol
gallstones are the most common type of gallstones. These gallstones contain mostly undissolved
cholesterol and are yellow in color. Pigment gallstones are when your bile contain too much
bilirubin and are either black or brown in color. The cause of gallstones are not yet completely found
but doctors figure they are caused by either your bile containing to much cholesterol, bile containing
to much bilirubin, or by your gallbladder not emptying correctly. Doctors can diagnose gallstones in
many ways. Either through blood test, MRCP, HIDA scan, endoscopic ultrasound, and ERCP.
Treatment for gallstones vary. It depends on how bad they are, and size. Most people get surgery to
remove their gallstones because of the pain. There are two diffrent types of surgerys to remove
gallstones and they are called Laparoscopic cholecystectomy and open

St. Joe's Case Summary
The patient is 66 year–old male who is brought to St. Joe's ER by BLS after being found with
altered mental status at home. The patient reports he used heroin 2 days prior to admission. The
patient was found by his brother hallucinatin with bladder or bowel incontinence the morning of
presentation. The patient has not eating in approximately 4 days. The patient himself denies having
any complaints, but he is a very poor historian. His medical history is significant for prior heroin
and cocaine abuse, alcohol abuse of unknown duration, hypertension, cirrhotic liver, he has had an
anterior cervical discectomy of C5–C7 with anterior compression in May of 2012 and a closed
reduction of C6–C7 billateral dislocation , cholecystectomy in the

Importance Of Team And Health Care
Importance of Team SA in Healthcare In the field of healthcare, IDT is widely accepted with a goal
to channel all the talents of different health care professionals in providing high quality care
(Bokhour, 2006). Here, differently trained professionals work on the same team to attain the goal of
returning the patient to his highest level of productivity and safety (Strasser, Uomoto & Smits,
2008). The interdisciplinary model or inter–professional model (Sheehan et al, 2007) is based on an
interpersonal collaboration approach. The team incorporates family members and patients
themselves along with other professionals. According to this concept, communication between all
the team members is very crucial in decision making and the care planning process. The authors
compared this model with other models like the medical model, multidisciplinary model and trans–
disciplinary model and stated that the effectiveness of this (IDT) approach is marked by a holistic,
patient oriented and collaborative approach (Behm & Grey, 2011). The study of team work is very
recent in medicine and is very much influenced by the work done in the aviation industry. This work
has demonstrated that implementing certain behaviors and adopting standardized tools to assess
teamwork can be very effective in enhancing teamwork and reducing risk of errors (Leonard, 2004).
A good example of the importance of teamwork in hospitals are patient handovers. Successful
handovers are an essential process in patient

Epigastric Pain Basis: A Case Study
CC Continued abdominal pain radiating to back. S The patient is a 44–year–old female who I saw
for her physical in June 18, 2015. At that point, she was complaining of epigastric pain that radiated
into her back. I did ask her to start Prilosec over the counter, daily. Initially, we had called her and
she reported that this was helpful, although now, she reports that at the same time, she had a cold
and she was more focused on the cold than the epigastric pain. Subsequently, she states her pain
really has not changed and she continues to have epigastric pain, which does radiate to her mid–
back. Her bowel movements have been soft, she has been somewhat nauseous, but no vomiting. She
has not see any blood in her stools. She does think

Candler V. Persuad Essay
Candler V.Persaud Case Study
Candler v. Persaud Case Study
In order for physicians to get clinical surgery privileges to perform certain procedures in the realm
of their practices, they have to obtain adequate abilities and experiences. There must be a
combination of knowledge in theory and experience earned during practical situations. Without a
clear confirmation of such combination of theory and practical knowledge, physicians are not in a
safe position to perform any procedures. In the hospital setting, physicians must receive the clinical
surgery privileges from hospital to perform any procedure there. It is incumbent to hospital to make
sure all due diligence is followed by the physician. The hospital must check and cross ... Show more
content on Helpwriting.net ...
That is where credentials are important to know to what specifically the surgeon is specialized in.
For example, the fact that someone is an experience surgeon to deliver pregnant women does not
mean he/she has experience and practice to operate on a woman have a breast reduction. In other
undeveloped countries, I am aware of one surgeon is able to operate on people with many different
issues. I have heard the story of Gynecologist surgeon who also operates on children with other birth
defect. But, I like the way it is over here in this country, there is almost surgeons who practice very
specific part of the body. This way, it is safer, and without much doubt one knows that he/she is
dealing with someone who is trained, educated, and experienced in one particular field. In some
particular cases, hospitals have granted privileges to physicians/surgeons to carry out certain
procedures, but cannot depend on theoretical knowledge. Medicine is one the fields where
theoretical knowledge only will not be considered as proof of experience. Also, no one can claim to
be experienced through training and practice without the required years of theoretical knowledge.
Both are required here, theory and practice. However, specific practice is required. For the surgeon
needs to specialize in a particular area.
Not all surgical procedures are the same, each procedure necessitates very specific skills, expertise,
knowledge, and

Sample Nursing Case Studies
Client age: 90 Gender: Female (Accompanied by Daughter) Chief complaint: Altered Mental Status,
Anorexia History of Present Illness: Onset: female (Black) patient reports symptoms of fever (102.4
in a.m.) with decreased appetite with onset of symptoms, urinary frequency, urgency, dysuria and
nausea. The family also reports that for the last two days the patient has been increasingly confused,
and does not recognize family. Past Health History: Patient is current on all childhood vaccinations.
Patient had hysterectomy in 1995 for Cervical dysplasia and cholecystectomy in 1998. No other
surgeries reported. Patient denies tobacco or ETOH use. Patient has history of Gastric Ulcer disease
controlled with medications (non–bleeding). Patient is primarily bedbound at home secondary ...
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TM is intact, pearly gray, with good cone of light evident. Whisper test deferred. Webber/Rinne test
deferred. No tenderness over the mastoid process. NOSE & SINUSES: Differed MOUTH &
TROAT: Lips are pink, midline and symmetrical with no cracks, lumps, scaliness or ulcers. Gums
are pink. Hard palate intact with no ulcer. Tongue is midline with no ulcerations or swelling. Patient
is missing all but two lower teeth. SKIN & NAILS: Skin is warm, dry, pale, and intact. Turgor–
instant recoil. Nail beds pink, no clubbing or cyanosis of nails noted. Cap. Refill < 3 secs. No rash,
petechiae, ecchymosis, redness or suspicious nevi noted on skin. Patient skin is dry. Patient has scar
from previous cholecystectomy. BREAST & AXILLAE: Deferred CHEST/LUNGS: Chest
symmetrical and without deformity, AP/lateral diameter 1:2. Respirations 18, even and unlabored.
Chest wall expansions equal bilaterally, no use of accessory muscles. Thorax is symmetric with
good expansion. Lungs CTA bilaterally. No tenderness to chest wall on

Gallstone Case Study
The prevalence of gallstones varies with the geographical region. In the western world, the rates
range from approximately 8% in men to 16% in women.3 The typical course of cholelithiasis often
begins as asymptomatic gallstones found incidentally on imaging studies. However, 2% of
asymptomatic patients become symptomatic per year.8 Biliary colic is the most common symptom
to manifest and approximately 20–40% of patients have recurring pain.8 Asymptomatic patients
who have calcified gallbladders or large stones >2cm have a greater risk for gallbladder carcinoma
and as a result these patients are recommended to have prophylactic cholecystectomy.8 Medical
treatment is only advised for certain types of patients and is not the ideal treatment ... Show more
content on Helpwriting.net ...
The initial plan started with ordering a CBC, CMP, amylase and lipase STAT. These are all standard
labs that help to rule out gallbladder pathology as well as our other differential diagnoses. Her vital
signs were stable and the physical exam revealed only moderate TTP of the RUQ and epigastric
region. The lab results revealed no leukocytosis, no elevation of liver enzymes, bilirubin, amylase,
lipase, alk phos or any other signs of cholecystitis, cholangitis, pancreatitis or other potential signs
of infection. The plan of care began with keeping the patient NPO. This is recommended as this
keeps the patient from further pain secondary to food stimulating gallbladder contraction.5 It also
allows the patient to be prepared for surgery if urgent cholecystectomy is required. The next step
was beginning IV normal saline to keep her well hydrated. After this we began to give her
medication through the IV including Zofran for her nausea. Zofran is an effective anti–emetic and
there were no contraindications for use in this patient. We also gave her Morphine 2 mg IV for pain
control. Opioids are an effective option for a patient with significant biliary colic.6 Although
NSAIDS are another option for pain control, PUD was part of the differential diagnosis so NSAIDS
were not an appropriate therapy. We ordered an abdominal ultrasound as this is the diagnostic test of
choice for cholelithiasis. The ultrasound revealed multiple gallstones in the gallbladder, some mild
gallbladder thickening, and some dilatation of the common bile duct. At this point we consulted GI
who scheduled the patient for MRCP in the morning in order rule out choledocholithiaisis. We also
consulted the surgery team who admitted the patient. The stated they would likely plan for
laparoscopic

Research Paper On Cholelithiasis
Cholelithiasis: Stones in the Gallbladder The presence of gallstones in the gallbladder, clinically
known as Cholelithiasis, is a very common medical condition affecting most of the world's
population. It is mostly prevalent in the western countries. "In the U.S. alone, gallstones are present
in 8–20% of the population by the age of 40" (University of Connecticut Medical Center, n.d.).
Stones can come in varies sizes and two main types. This condition can present itself with absolutely
no symptoms and completely go unnoticed but is most commonly diagnosed with the patient
experiencing biliary colic. Ultrasound is considered most accurate in diagnosing stones. Treatment is
completely dependent on the severity of the condition but most commonly ... Show more content on
Helpwriting.net ...
For those that are symptomatic or become symptomatic treatment varies on severity and where the
stone is located. The most common treatment is cholecystectomy, the surgical removal of the
gallbladder. Patients that will benefit from this procedure the most are "those with large (>2 cm)
gallstones, those who have a nonfunctional or calcified (porcelain) gallbladder on imaging studies
and who are at high risk of gallbladder carcinoma, those with spinal cord injuries or sensory
neuropathies affecting the abdomen, and those with sickle cell anemia in whom the distinction
between painful crisis and cholecystitis may be difficult" (Heuman, 2015). This procedure may be
done open or laparoscopic. Open cholecystectomy involves the surgeon creating a large opening in
the abdomen and using direct exploration to remove the gallbladder. This technique is not common
today and laparoscopic is more favorable. During a laparoscopic cholecystectomy procedure,
surgeons will make multiple small abdominal incisions and insert a video endoscopy and other
instruments to remove the gallbladder by sections. This technique is less invasive and results in less
postoperative discomfort and improved cosmetic results. For those patients who decline surgery or
are at high risk for surgery, gallbladder stones may be dissolved. This treatment may take up to two
years or longer for complete dissolution and the stones may return. The best applicants for this
treatment are those with small stones made of cholesterol. "Ursodeoxycholic acid 4 to 5 mg/kg po
bid or 3 mg/kg po tid (8 to 10 mg/kg/day) dissolves 80% of tiny stones <0.5cm in diameter within 6
mo." (Siddiqui, 2013). A more rapid treatment for those not able to have surgery is shock wave
lithotripsy (ESWL) of the gallbladder. This is a therapeutic technique where sound waves are

Cholelithiasis is the medical term for gallstones. The gallbladder is a small, pear–shaped organ
situated in the upper part of the right abdomen below the liver. Gallstones are solid particles that
build up in the gallbladder. The size of gallstones can range in size from that of sand grain to that of
a golf ball. There may be a single large stone or several small and large stones of different sizes in
the gallbladder. Approximately 10–15% of the adult population in the west is known to develop gall
stones annually. Stones in the gallbladder form due to an imbalance in the chemical constituents of
bile. Due to this, one or more components of bile get precipitated. The exact reason for this
imbalance is not known. Patients suffering from this disease may experience a sudden pain ( called
gall bladder attack, also called biliary colic)in the upper right abdomen. This pain occurs when the
biliary ducts are blocked by the gallstones. Gallstones have been observed in people of all age
groups. However, the risk increases with age. Obesity increases the risk of formation of gallstones.
In females, oestrogen leads to secretion of more cholesterol, excess of which leads to formation of
stones. Thus, the risk is higher in females. Genetic reasons also contribute to cholelithiasis. Other
factors that increase risk of gallstones include ... Show more content on Helpwriting.net ...
After the gallbladder is surgically removed, bile pours out of the liver directly into duodenum.
Surgical removal is carried out in two different ways. Accordingly these two methods are called
laparoscopic cholecystectomy and open cholecystectomy. In the former, minor incisions are made in
the abdomen of the patient and a laparoscope is inserted. A laparoscope is a tube which has a video
camera attached to it. The doctor can see a magnified image of the internal organs on video monitor
and accordingly use the tools to remove the gall

Pnv Case Studies
Results
There were no significant differences between the two groups with respect to age, sex, weight,
duration of surgery or anaesthesia. [Table1] The incidence of nausea was significantly lower in the
palonosetron group (12%) compared to ondansetron group (30%) (P0.05) . [Table 2] Furthermore,
there were no statistically significant differences in the incidence of adverse events among the two
groups. [Table 3]
Discussion
Despite continuing advances in anaesthetic technique and surgical skills PONV is the most frequent
and most unpleasant adverse outcome of surgery and general anesthesia.[1] PONV is distressing and
potentially detrimental to a patient's recovery as it can result in wound dehiscence, bleeding,
aspiration of gastric contents, electrolyte imbalances, and delayed hospital discharge.[4] The
incidence of PONV following laproscopic ... Show more content on Helpwriting.net ...
Palonosetron has already been proven effective and safe in prevention of Chemotherapy induced
nausea and vomiting. [12, 17, 18, 19] Therefore, we decided to conduct a study to evaluate and
compare the efficacy of palonosetron which is a newer 5–HT3 antagonist against ondansetron.
The study dose of i.v. Ondansetron was 8mg and that of i.v. Palonosetron was .075mg, which was as
per the recommendations of Tramer and colleagues and Candiotti et al. [19, 21]
The need for rescue antiemetic in our study was significantly higher in the Ondansetron group
(40%) as compared to palonosetrone (18%), which is due to the weaning of antiemetic effect of i.v.
Ondansetron which lasts for 4–5 h. In our study, the overall incidence of PONV score was found to
be (28%) in group palonosetrone and (52%) in group ondansetron , due to difference in t½.

Disadvantage Of Laparoscopic Surgery
LAPAROSCOPY
Laparoscopy surgery is a minimally invasive type of surgery that is used to diagnose and treat
various forms of disorders. It is performed with the help of a remotely controlled surgical device
known as a Laparoscope.
What is Laparoscopic Surgery?
Laparoscopic surgery is a minimally invasive surgical procedure that uses a laparoscope to
diagnose, treat and perform various types of surgeries on many medical disorders. Laparoscopic
surgery is also known as Minimally Invasive Surgery (MIS), keyhole surgery, band aid surgery
among other names.
This technique consists of making very few and minute incisions far from the affected area to insert
a laparoscope into the body. The main part of this surgery is the use of laparoscope which is a length
of surgical–grade fiber optic system that allows a clear and ... Show more content on
Helpwriting.net ...
In the Robotic minimally invasive surgical procedure the surgeon uses two master controls to
operate four robotic limbs. The surgeon operates from a distance with the help of a video console
that provides a high–resolution 3–dimensional view of the operation area inside the body. A distinct
advantage of robotic laparoscopic surgery is that it can be used to perform surgical procedures from
a remote location without the surgeon's presence in the operating room.
Gynecology Laparoscopy
Gynecology laparoscopy procedures are the new alternative to conventional gynecology surgery.
The doctor will be able to do a better diagnosis with a laparoscope camera to determine the location
and extent of the disorder. This procedure also has miniature surgical instruments that allow the
surgeon to perform the required procedure.
Laparoscopic gynecology surgery can be used to perform delicate surgical procedures such as
ovarian cyst removal, hysterectomy, tubal ligations, etc.
Pelvic

Recounters Medical Center Journal Report
Saunders Medical Center OR: Preceptor Day Nine This is my ninth clinical shift with my preceptor
at Saunders Medical Center in Wahoo, NE, and it was on May 15, 2018 (Wednesday). Today I had
the chance to work back in the OR. I had the choice to stay after my shift to place an IV in a
treatment room patient, so I did as well. My duties were to place IV's, gather report, preoperative
care, a little bit of postoperative care, and helping clean up the OR after surgery. The patient census
included: K. S. a 51–year–old female scheduled for a laparoscopic cholecystectomy with
intraoperative cholangiogram; and T. M. a 30–year–old male scheduled for excision sebaceous cysts
x2 scalp with full thickness skin graft from left neck donor site. Plus, one IV on a treatment patient,
which I don't have the information for this patient because I was only going in to place the IV. It was
an eventful day and I learned how to work under pressure when things can turn for the worse in OR;
it was a learning experience and I'm forever grateful! My shift started ... Show more content on
Helpwriting.net ...
Kampfe had the patient under general anesthesia to do this procedure. The patient T. M. is a 30–
year–old male; he has mental retardation/special needs. The patient had to be in the right lateral
recumbent (right–sided position) position; we transferred him to the OR table on his back (supine)
first, while the CRNA could intubate him. The anesthesiologist stated that the patient had a short
neck and big tongue, with a little mouth, and he said it was extremely hard to intubate him. The
CRNA struggled and eventually got it, but said, if the patient wasn't already missing the three teeth
on his left upper mouth, he would've knocked them out while intubating him. The surgery went
great as I stated a little about the procedure in the first paragraph. Dr. Kampfe cut the smaller side
cyst and then did the bigger cyst next. After that was done he cauterized the areas to stop the
bleeding and then did the skin

Bile Duct Leak Research Paper
Introduction Bile duct leak is an infrequent but serious disorder. The cause of bile duct leak can be
either iatrogenic or more rarely, traumatic. (1) The great majority (95%) occurs after hepatobiliary
surgery and the most common cause is related to open and laparoscopic cholecystectomy. (2) Biliary
injury occur in 0.1 – 0.2 % and 0.3 – 0.8 % after open and laparoscopic cholecystectomy
respectively. (3) Postoperative bile leak is usually the result of oblivious injury to the bile ducts,
inappropriate ligation of the cystic duct stump, or leakage from the liver bed or the drainage site and
usually precipitated with distal block from residual stones or strictures. (4) Minor leakage may stop
spontaneously, while major leakage may be a serious

Laparoscopic Cholecystectomy: A Case Study
Darren Roberts: 55–year–old male with a history of Hypertension, and Hyperlipidaemia who has
gone in for a Laparoscopic Cholecystectomy. Six potential problems post–operatively in order are
Airway blockage due to possible tongue blockage as evidenced by the fact that Darren is a Smoker
and Obese which are both potential factors causing the tongue to block the airways after surgery
adding to this is the fact that anyone who has been under aesthetic and have problems with their
tongue blocking the airway. (Brown et al, 2015) Nausea and vomiting could also cause blocked
airway post–surgery as evidenced by the fact that laparoscopic surgery can cause nausea and
vomiting in patients. (Graham, 2008)
Breathing issues include Respiratory depression ... Show more content on Helpwriting.net ...
(2013). Turning the tide on respiratory depression. Nursing2015, 43(9), 38–45.
Dempsey, M. F. a. J. (2014). Textbook of Medical–Surgical Nursing (K. Enkelaar Ed.): Lippincott
Williams and Wilkins.
Di Brown, H. E., Sharon Lewis, Margret Heitkemper, Linda Bucher, and I Camera. (2013). Lewis's
medical–surgical nursing Assessment and Management of Clinical Problems (Third ed.).
Chatswood: Mosby Elevier.
Erbs, K. a. (2015). Fundamentals of Nursing (3 Ed. Vol. 2). Melbourne: Pearson Australia.
Graham, L. (2008). Care of patients undergoing laparoscopic cholecystectomy. Nursing Standard,
23(7), 41–48.
Lee, L. A. (2015). Postoperative Opioid–induced Respiratory Depression: A Closed Claims
Analysis. Anesthesiology, 122(3), 659.
Lemone, B., Levett–Jones, Moxham Reid–Searl, Berry, Carville, Hales, Knox, Luxford, and
Raymond. (2014). Medical–Surgical Nursing Critical Thinking for Person–Centered Care (Vol. 1):
Pearson Australia.
MIMS. (2016). MIMS online.
Prado, C. B. C., Barichello, E., Pires, P. D., Haas, V. J., & Barbosa, M. H. (2015). Occurrence and
factors associated with hypothermia during elective abdominal surgery. Acta Paulista De
Enfermagem, 28(5), 475–481.

Gallstone Ileus Case Study
The current approaches to surgical management of gallstone ileus are: (1) enterolithotomy,
cholecystectomy and fistula repair (single–stage surgery), (2) enterolithotomy with delayed
cholecystectomy and fistula closure (two–stage surgery) and (3) simple enterolithotomy (most
reported surgical procedure). Proponents of the single–stage procedure cite recurrence and increased
risk of developing cholangitis or gallbladder carcinoma as reasons for performing concurrent
cholecystectomy and fistula closure [18]. Those who support the two–stage procedure or simple
enterolithotomy point to high mortality rates of single–stage procedures and low rates of recurrence
and gallbladder carcinoma as reasons ... Show more content on Helpwriting.net ...
Moreover, recurrence rates, from retained stones missed during initial surgery or formation of new
gallstones, were the same in both groups. Thus, the one–stage procedure, while associated with
higher mortality rates, did not reduce recurrence rates as its proponents have predicted. Similarly,
results from many other collective retrospective studies also demonstrate higher mortality rates with
the single–stage procedure (Table 1). While these studies suffer from lack of power and statistical
significance due to limited patient pools and the small number of patients who undergo single–stage
procedure, statistically significant differences in operative time have been pointed out by several
authors including Tan et al. [20] and Doko et. al. [23]. Further, Doko et al. also reported statistically
significant increase in early post–operative morbidity associated with urgent fistula repair in a
single–stage procedure at 61.1% compared to 27.3% with enterolithotomy alone (one tailed,
P=0.043). They found an urgent fistula closure was significantly associated with post–operative
complications with an odds ratio of 12.1 [[CI]: 1.2 – 121.5, P=0.046] and concluded that the single–
stage procedure should be reserved only for highly selected patients with absolute indications (acute

Idiopathic Interstitial Pulmonary Firosis ( Ipf ) Essay
Idiopathic interstitial pulmonary firosis (IPF) is considered the most common form of interstitial
lung disease (ILD). Its course is a progressive of and its cause is unknown. Idiopathic interstitial
pulmonary firosis a‫ٶ‬ect the gas exchange as it results in chronic inflmmation and progressive firosis
of lung parenchyma. Нe signs and symptoms of this disease consist of progressive dyspnea,
hypoxia, clubbing and crepitations at the lung bases [1]. IPF is a fatal lung disease; the natural
history is variable and unpredictable: Most patients with IPF demonstrate a gradual worsening of
lung function over years; a minority of patients remains stable or declines rapidly. Some patients
may experience episodes of acute respiratory worsening despite previous stability. НH
ATS/ERS/JRS/ALAT 2011 Revised Diagnostic Criteria Нe diagnosis of IPF is based on the absence
of a known cause of lung firosis computed tomography (CT) fidings and, in cases with CT
abnormalities that are not classical for IPF, the use of pathological criteria [2]. An 2‫ٹ‬FLDO
ATS/ERS/JRS/ALAT Statement IPF is defied as a specifi form of chronic, progressive firosing
interstitial pneumonia of unknown cause, occurring primarily in older adults, limited to the lungs,
and associated with the histopathologic and/or radiologic pattern of unspecifid interstitial
pneumonia (UIP) [3]. НH Diagnosis of IPF Requires 1. Exclusion of other known causes of
interstitial lung disease (ILD) Нe presence of a unspecifid interstitial

Research Paper On Cholecystitis
The most common presentation of cholecystitis in patients is intermittent, moderate to severe pain in
the upper right quadrant of the abdomen, often radiating towards the back or between the shoulder
blades due to accompanying inflammation of the peritoneum of the diaphragm, which is innervated
by spinal cord segments C3–C5, which also supply sensation to the skin of the shoulder (Munson
Traister, 2005) (Drake et al., 2009). If the biliary tract is blocked or inflamed, patients may present
with jaundice; or if gallstones are passed along the duct, a constant pain may be experienced in the
upper right abdomen (Munson Traister, 2005).
Symptoms of acute cholecystitis may include vomiting and nausea; with fever and constant severe
right quadrant ... Show more content on Helpwriting.net ...
Drainage of the gallbladder (cholecystostomy) may also be used when a full cholecystectomy
cannot be performed or deemed unnecessary. With successful removal of the gallbladder and
subsequent treatment, the prognosis is usually very good in that the condition is usually cured
completely with little lasting effects, however some minor complications of the procedure may
include bile leakage or minor bleeding (Katabathina et al., 2015). Without surgery, serious
complications such as gangrene, perforation of the gallbladder or infection may occur and prove
fatal (Huffman and Schenker, 2010). Even after removal, patients may experience abdominal pain
for a few days or a change in bowel habits (Elwood,

Hypnotherapy Case Studies
Subjective:
Chief Complaint: N.G., a 33 year old Hispanic female who appears reliable presents today with
complaints of something is in my left eye.
HPI: This patient claims that a piece of plastic off of a milk crate broke and flew directly into her
left eye when she was attempting to set it down yesterday evening. She claims that the pain started
immediately and was a 10/10. The pain has only improved slightly overnight to a 8/10 this
morning. She describes this pain as a sharp, burning and stabbing type of pain. She has obtained
some relief from rinsing her left eye out repeatedly and then applying cool compresses and ice
packs. She claims that opening her eye makes the pain worse and causes her eye to water. She
denies any radiation of ... Show more content on Helpwriting.net ...
Plan of Care: No laboratory work ordered at this time. Patient prescribed Tobramycin ophthalmic
ointment 1/4 to 1/2 inch ribbon to lower conjunctiva every four hours while awake (Medscape,
2014). Patient instructed to keep eye clean using a dilute baby shampoo solution twice daily. The
patient is instructed to seek immediate medical intervention for visual changes, fever greater than
100.0, or increasing ocular pain. Return for follow–up appointment in two days (Goolsby Grubs,
2011). Continue current medication regime as previously prescribed.
Evaluation: I was provided the opportunity to observe and participate in fluorescein staining of the
eye to assess for scleral abrasions. Bailey, Buttaro, Sandberg–Cook, and Trybulski (2013) claim that
the degree of injury is determined by the size of the object and the amount of mechanical energy the
foreign object obtained prior to reaching the surface of the eye. This patient was in severe pain, yet
received only a minor trauma to conjunctival aspect of the upper eyelid. It is imperative for her to
keep her follow–up appointment as infection and ulcers are common after ocular injuries (Bailey et
al., 2013).

Laparoscopic Cholecystectomy Essay
Cholelithiasis in patients with cirrhosis is two times more common as compared with general
population. Previously Laparoscopic Cholecystectomy was contraindicated in cirrhotic patients,
with the time and more expertise has replaced open cholecystectomy as the standard of care of
Cholelithiasis. Improvements in operating skills and equipment have gradually permitted its
application in several previously.
Over the years, with the more experience in Laparoscopic Cholecystectomy has resulted in an
increasing number of authors reporting that Laparoscopic Cholecystectomy can be performed safely
in cirrhotic patients.18
Although Laparoscopic Cholecystectomy became very famous, cirrhosis was initially considered a
relative contraindication. 19, 20 ... Show more content on Helpwriting.net ...
It is well known that Laparoscopic Cholecystectomy patients had shorter hospital stays and
operative times, faster operative rehabilitation, reduced wound complications.29, 30
In our study the time duration of laparoscopic cholecystectomy was less 50–75 min as compare to
other studies more than 96 min study done by saleh–El–awadi,31 Alessandra Puggioni30 more than
100 minutes. Our results of conversion to open cholecystectomy from laparoscopic cholecystectomy
were 9% same with the published in the literature.32, 33, 34 It is not a complication of surgery but it
can avoid the more serious complication like if bleeding point can't be seen or controlled properly
and distorted anatomy of the calot's triangle.
While performing the laparoscopic cholecystectomy, special care should be taken in port formation
to avoid injury to dilated abdominal wall veins. The subxiphoid ports was placed more to the right
of the midline to avoid the falciform ligament and accompanying umbilical vein. We believe in
meticulous care to maintain haemostasis so, blunt dissection was avoided to minimize bleeding once
and variety of techniques other than electrocautary, including Ligasure is

Surgical Robots And The Field Of Surgery

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