The Optimizing Intraoperative Nursing Care: Hypothermia Management in Exploratory Laparotomy for Adhesiolysis and Jejunal Diverticulectomy

Muhammad Alfarizi

doi:10.58545/jkmi.v4i1.415

Authors

Muhammad Alfarizi Operating Theatre Nurse, Siloam Hospital Surabaya, Indonesia

DOI:

https://doi.org/10.58545/jkmi.v4i1.415

Abstract

Exploratory laparotomy surgery is a procedure that is often found in patients with adhesive obstruction ileus. In the intraoperative phase, exploratory laparotomy takes a long time and exposure to cold environments and anesthetic drugs often causes hypothermia which has an impact on serious complications. The purpose of this study was to analyze intraoperative hypothermia management interventions in patients undergoing exploratory laparotomy surgery with adhesiolysis and jejunal diverticulectomy. The study design used a case study with a nursing care approach. The research sample was Mr. S with a diagnosis of adhesive obstruction ileus taken using the convenience sampling technique. Data collection was carried out by observation during surgery and documentation studies with a perioperative nursing care format. Hypothermia management was carried out by providing warm irrigation interventions of the gastrointestinal organs with 0.9% NaCl fluid at a temperature of 38^0C and laparotomy gauze when starting exploration for 4 hours according to the duration of surgery. The results of the study showed significant clinical improvements in body temperature, skin, blood pressure, pulse and gastrointestinal motility. The irrigation method with warm NaCl 0.9% during exploratory laparotomy is very effective in overcoming intraoperative hypothermia and facilitating the adhesiolysis process in the gastrointestinal organs.

Keywords:

Hypothermia, Exploratory Laparotomy, Warm Irrigation, Intraoperative

Downloads

Download data is not yet available.

References

Abdelbasset, W., & Elnegamy, T. (2015). Effect of Chest Physical Therapy on Pediatrics Hospitalized With Pneumonia. International Journal of Health and Rehabilitation Sciences (IJHRS), 4(4), 219. https://doi.org/10.5455/ijhrs.000000095

AbdelHalim, H. A., AboElNaga, H. H., & Fathy, K. A. (2016). Comparison between active cycles of breathing with postural drainage versus conventional chest physiotherapy in subjects with bronchiectasis. Egyptian Journal of Chest Diseases and Tuberculosis, 65(1), 157–165. https://doi.org/10.1016/j.ejcdt.2015.08.006

Aminasty Siregar, D. (2020). Faktor-Faktor Yang Berhubungan Dengan Kejadian Pneumonia Pada Balita Rumah Sakit Umum Daerah (RSUD) Kota Padangsidimpuan Tahun 2020. Ilmiah Kohesi, 4(2), 31–42. https://kohesi.sciencemakarioz.org/index.php/JIK/article/view/122

Andrade, L. Z. C., Da Silva, V. M., Lopes, M. V. D. O., Chaves, D. B. R., & Távora, R. C. D. O. (2014). Desobstruc¸ão ineficaz de vias aéreas: Prevalência e espectro de seus indicadores clínicos. ACTA Paulista de Enfermagem, 27(4), 319–325. https://doi.org/10.1590/1982-0194201400054

Belli, S., Prince, I., Savio, G., Paracchini, E., Cattaneo, D., Bianchi, M., Masocco, F., Bellanti, M. T., & Balbi, B. (2021). Airway Clearance Techniques: The Right Choice for the Right Patient. Frontiers in Medicine, 8(February), 1–10. https://doi.org/10.3389/fmed.2021.544826

Broek, R. P. G., Krielen, P., Di Saverio, S., Coccolini, F., Biffl, W. L., Ansaloni, L., Velmahos, G. C., Sartelli, M., Fraga, G. P., Kelly, M. D., Moore, F. A., Peitzman, A. B., Leppaniemi, A., Moore, E. E., Jeekel, J., Kluger, Y., Sugrue, M., Balogh, Z. J., Bendinelli, C., … van Goor, H. (2018). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO). World Journal of Emergency Surgery, 13(1), 13–24. https://doi.org/10.1186/s13017-018-0185-2

Chaves, D. B. R., Beltrão, B. A., Pascoal, L. M., Oliveira, A. R. de S., Andrade, L. Z. C., dos Santos, A. C. B., de Moura, K. K. M., Lopes, M. V. de O., & da Silva, V. M. (2016). Defining characteristics of the nursing diagnosis “ineffective airway clearance.” Revista Brasileira de Enfermagem, 69(1), 92–98. https://doi.org/10.1590/0034-7167.2016690114i

Chaves, G. S. S., Freitas, D. A., Santino, T. A., Nogueira, P. A. M. S., Fregonezi, G. A. F., & Mendonça, K. M. P. P. (2019). Chest physiotherapy for pneumonia in children. Cochrane Database of Systematic Reviews, 2019(1). https://doi.org/10.1002/14651858.CD010277.pub3

Collins, S., Budds, M., Raines, C., & Hooper, V. (2019). Risk Factors for Perioperative Hypothermia: A Literature Review. Journal of Perianesthesia Nursing, 34(2), 338–346. https://doi.org/10.1016/j.jopan.2018.06.003

Corten, L., Jelsma, J., & Morrow, B. M. (2015). Chest physiotherapy in children with acute bacterial pneumonia. South African Journal of Physiotherapy, 71(1), 1–10. https://doi.org/10.4102/sajp.v71i1.256

Dai, Z., Zhang, Y., Yi, J., & Huang, Y. (2022). Validation of a Prediction Model for Intraoperative Hypothermia in Patients Receiving General Anesthesia. International Journal of Clinical Practice, 2022. https://doi.org/10.1155/2022/6806225

De Simone, B., Alberici, L., Ansaloni, L., Sartelli, M., Coccolini, F., & Catena, F. (2019). Not all diverticulites are colonic: Small bowel diverticulitis – A systematic review. Minerva Chirurgica, 74(2), 137–145. https://doi.org/10.23736/S0026-4733.18.07745-3

Efni, Y., Machmud, R., & Pertiwi, D. (2016). Faktor Risiko yang Berhubungan dengan Kejadian Pneumonia pada Balita di Kelurahan Air Tawar Barat Padang. Jurnal Kesehatan Andalas, 5(2), 365–370. https://doi.org/10.25077/jka.v5i2.523

Fikri, B. A. (2017). Analisis Faktor Risiko Pemberian Asi Dan Ventilasi Kamar Terhadap Kejadian Pneumonia Balita. The Indonesian Journal of Public Health, 11(1), 14. https://doi.org/10.20473/ijph.v11i1.2016.14-27

Ghimire, P., & Maharjan, S. (2023). Adhesive Small Bowel Obstruction: A Review. Journal of the Nepal Medical Association, 61(260), 390–396. https://doi.org/10.31729/jnma.8134

Gomes, G. R., & Donadio, M. V. F. (2018). Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis. Archives de Pediatrie, 25(6), 394–398. https://doi.org/10.1016/j.arcped.2018.06.004

Hartati, S., Nurhaeni, N., & Gayatri, D. (2012). Faktor Risiko Terjadinya Pneumonia pada Anak Balita. Jurnal Keperawatan Indonesia, 15(1), 13–20. https://doi.org/10.7454/jki.v15i1.42

Kovachev, L. (2019). Simple , Easy and Accessible Way for Abdominal Adhesions Separation. Austin Journal of Surgery, 6(16), 6–7. https://austinpublishinggroup.com/surgery/fulltext/ajs-v6-id1202.pdf

Lebert, P., Millet, I., Ernst, O., Boulay-Coletta, I., Corno, L., Taourel, P., & Zins, M. (2018). Acute Jejunoileal Diverticulitis: Multicenter Descriptive Study of 33 Patients. AJR. American journal of roentgenology, 210(6), 1245–1251. https://doi.org/10.2214/AJR.17.18777

Mueller, T. C., Kehl, V., Dimpel, R., Blankenstein, C., Egert-Schwender, S., Strudthoff, J., Lock, J. F., Wiegering, A., Hadian, A., Lang, H., Albertsmeier, M., Neuberger, M., Von Ehrlich-Treuenstätt, V., Mihaljevic, A. L., Knebel, P., Pianka, F., Braumann, C., Uhl, W., Bouchard, R., … Reim, D. (2024). Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection after Laparotomy: A Randomized Clinical Trial by CHIR-Net. JAMA Surgery, 159(5), 484–492. https://doi.org/10.1001/jamasurg.2023.7985

Navaratnam, V., Forrester, D. L., Eg, K. P., & Chang, A. B. (2019). Paediatric and adult bronchiectasis: Monitoring, cross-infection, role of multidisciplinary teams and self-management plans. Respirology, 24(2), 115–126. https://doi.org/10.1111/resp.13451

Pascoal, L. M., Lopes, M. V. de O., Silva, V. M. da, Chaves, D. B. R., Beltrão, B. A., Nunes, M. M., & de Castro, N. B. (2020). Prognostic indicators of short-term survival of ineffective airway clearance in children with acute respiratory infection: a longitudinal study. Contemporary Nurse, 56(4), 376–387. https://doi.org/10.1080/10376178.2020.1813045

Patola, A., & Tridiyawati, F. (2024). Managing Hypothermia in Emergency Exploratory Laparatomy: A Case Report. Jurnal Keperawatan Komprehensif, 10(April), 203–211.

Peixoto, C. de A., Ferreira, M. B. G., dos Santos Felix, M. M., Pereira, C. B. de M., Cândido, J. V., Rocha, V. F. R., Ferreira, L. A., & Barbosa, M. H. (2021). Factors contributing to intraoperative hypothermia in patients undergoing elective surgery. Perioperative Care and Operating Room Management, 22(December 2020). https://doi.org/10.1016/j.pcorm.2020.100150

Pereira, N. H. C., & De Mattia, A. L. (2019). Postoperative complications related to intraoperative hypothermia. Enfermeria Global, 18(3), 270–284. https://doi.org/10.6018/eglobal.18.3.328791

Phillips, J., Lee, A., Pope, R., & Hing, W. (2020). Effect of airway clearance techniques in patients experiencing an acute exacerbation of bronchiectasis: a systematic review. Physiotherapy Theory and Practice, 36(12), 1300–1315. https://doi.org/10.1080/09593985.2019.1579286

Potter, P., & Perry, A. (2016). Fundamental Keperawatan Edisi 7 Buku 3 (3rd ed.). Salemba Medika.

PPNI. (2017). Standar Diagnosis Keperawatan Indonesia: Definisi dan Indikator Diagnostik. Dewan Pengurus Pusat PPNI.

PPNI. (2018a). Standar Intervensi Keperawatan Indonesia. Dewan Pengurus Pusat PPNI.

PPNI. (2018b). Standar Luaran keperawatan Indonesia. Dewan Pengurus Pusat PPNI.

Rauch, S., Miller, C., Bräuer, A., Wallner, B., Bock, M., & Paal, P. (2021). Perioperative Hypothermia A Narrative Review. International Journal of Enviromental Research and Public Health. https://doi.org/10.3390/ijerph18168749

Ribeiro, E., Ferreira, R. C., Montanari, F. L., Botelho, M. T. de S. L., Correia, M. D. L., & Duran, E. C. M. (2021). Conceptual and operational definition of the components of the nursing diagnosis hypothermia (00006) in the perioperative period. Revista Brasileira de Enfermagem, 74(2), 1–9. https://doi.org/10.1590/0034-7167-2019-0684

Rigustia, R., Zeffira, L., & Vani, A. T. (2019). Faktor Risiko yang Berhubungan dengan Kejadian Pneumonia pada Balita di Puskesmas Ikur Koto Kota Padang. Health & Medical Journal, 1(1), 22–29. https://doi.org/10.33854/heme.v1i1.215

Sakari, T., Christersson, M., & Karlbom, U. (2020). Mechanisms of adhesive small bowel obstruction and outcome of surgery; A population-based study. BMC Surgery, 20(1), 1–8. https://doi.org/10.1186/s12893-020-00724-9

Schwanda, M., Brunner, S., Almeida, M. de A., Koller, M., Staub, M. M., & Ewers, A. (2024). Content validation of the NANDA‐I nursing diagnosis risk for perioperative.pdf. International Journal of Nursing Knowladge, 1–12. https://doi.org/10.1111/2047-3095.12491

Simegn, G. D., Bayable, S. D., & Fetene, M. B. (2021). Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review. Annals of Medicine and Surgery, 72(October), 103059. https://doi.org/10.1016/j.amsu.2021.103059

Sleiman, Z., Baba, R., Garzon, S., & Khazaka, A. (2020). The significant risk factors of intra-operative hemorrhage during laparoscopic myomectomy: A systematic review. Gynecology and Minimally Invasive Therapy, 9(1), 6–12. https://doi.org/10.4103/GMIT.GMIT_21_19

Sutriana, V. N., Sitaresmi, M. N., & Wahab, A. (2021). Risk factors for childhood pneumonia: a case-control study in a high prevalence area in Indonesia. Clinical and Experimental Pediatrics, 64(11), 588–595. https://doi.org/10.3345/CEP.2020.00339

Syahputra, D. A., Mashudy, A., & Dasrul. (2020). The effect of addition of dexamethasone into normal saline irrigation solution on Prevention of Intraperitoneal Adhesion Post Laparotomy in wistar rats (Rattus norvegicus). Annals of Medicine and Surgery, 59(441), 57–63. https://doi.org/10.1016/j.amsu.2020.08.053

Tong, J. W. V., Lingam, P., & Shelat, V. G. (2020). Adhesive small bowel obstruction – an update. Acute Medicine & Surgery, 7(1). https://doi.org/10.1002/ams2.587

Valji, R., Mehta, R., & Hicks, A. (2021). Re: Effectiveness of hypertonic saline nebulization in airway clearance in children with noncystic fibrosis bronchiectasis: A randomized control trial. Pediatric Pulmonology, 56(12), 4051–4052. https://doi.org/10.1002/ppul.25656

Xu, H., Wang, Z., Guan, X., Lu, Y., Malone, D. C., Salmon, J. W., Ma, A., & Tang, W. (2020). Safety of intraoperative hypothermia for patients: Meta-analyses of randomized controlled trials and observational studies. BMC Anesthesiology, 20(1), 1–13. https://doi.org/10.1186/s12871-020-01065-z

Yoshimura, S., Okata, Y., Samejima, Y., Miyauchi, H., Saito, M., Inoue, S., Fujioka, K., Iwabuchi, S., Kameoka, Y., Watanabe, A., Uemura, K., Tomioka, Y., & Bitoh, Y. (2023). Impact of peritoneal lavage temperature during laparotomy in a preterm peritonitis mouse model using cecal slurry. Journal of Pediatric Surgery Open, 2(February), 100016. https://doi.org/10.1016/j.yjpso.2023.100016

Yuliastati, & Arnis, A. (2016). Keperawatan Anak. Pusdik SDM Kesehatan, 1, 27–37. https://repository.stikesbcm.ac.id/id/eprint/429/

Zaman, S. S., Rahmani, F., Majedi, M. A., Roshani, D., & Valiee, S. (2018). A Clinical Trial of the Effect of Warm Intravenous Fluids on Core Temperature and Shivering in Patients Undergoing Abdominal Surgery. Journal of Perianesthesia Nursing, 33(5), 616–625. https://doi.org/10.1016/j.jopan.2016.12.010