Laparoscopy question - Forum

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John Dissector

Re: Laparoscopy question - Ärzteforum

Post#11 »

In most states I have practiced in, the nurses were not allowed as
part of their nurse practice act to make medical diagnoses. They
were permitted to make nursing diagnoses, such as lack of knowledge about
illness, comfort levels, etc.

In this case, of course, a pre-op diagnosis is not necessary, the basic
question is to the OR or not (of course yes) and when (as soon as
resuscitated enough, but as rapidly as possible).


Re: Laparoscopy question - Ärzteforum

Post#12 »

Can you believe how many physicians even surgeons pull
this "enema" routine? Here's a novel announcement--stool in the colon and
rectum is NORMAL! Stool in the colon does NOT cause peritonitis, sepsiws, or
abdominal pain! This idiotic reflex usually stems from stool being seen on a
flat plate of the abdomen, therefore...of course the stool is the problem!
You can always tell the amateurs who don't know what they're doing--scary!--
when you see enemas being given for acute abdominal pain!

User avatar
Old surgeon

Re: Laparoscopy question - Ärzteforum

Post#13 »

I'm fascinated by the concept that rigid proctoscopes are still being
used for diagnostic purposes. I guess I have been living in my own
little world, but do any other members use this venerable (if
somewhat medievil) piece of equipment?


Re: Laparoscopy question - Ärzteforum

Post#14 »

This Lady seems to have had a bowel perforation during dissection of the
adhesions . Following resuscitation she would need a second look as soon
as possible , this can start laparoscopically, but will surely need an
exploratory lap. P.S please use less abbreviations as we are not familiar
with all of them especially temp in F

User avatar
Lady Surgeon

Re: Laparoscopy question - Ärzteforum

Post#15 »

Let me take the time to tell "the rest of the story".
Although fortunately, this did not occur at my hospital or in my town, you
will see why my aim in "picking your brains" is to assist me in look ing in
close detail at standards of care, documentation standards and patient
advocacy so that nurses can learn from the unfortunate errors of others. I do
this on several lists and have found all providers of care very receptive and
cooperative in setting the highest standards of care

Indeed, as you all so correctly surmised, the lady had a perforation that
occurred at the time of the laparoscopy. The surgeon did "lay hands upon" and
examine in the ER. But unfortunately, his diagnosis was limited to "mild"
ileus and hypokalemia. He chose a conservative route. Although an ER nurse did
discuss the "very sick pt" with an ER MD, he chose to wait and let the surgeon
manage her. Unfortunately, she deferred without pursuing his or the surgeon's
decision without questioning what in her mind should have been an obvious
post-op complication. As did the staff on the floor. Seems these nurses
practice in a setting in which nurses DO limit their care to nursing
diagnoses. Although this patient received appropriate discharge teaching, when
she followed that advice, the nurse's caring for her several days postop
focused on her alteration in electrolyte balance and her alteration in comfort
(nursing diagnoses) rather than taking on their role as patient advocate and
questioning why this patient "looked so sick" and was experiencing this
extreme level of pain with just a mild ileus and why she was so hypokalemic
and in need of immediate fluid resuscitation (as all of you recommended). The
nurses on the floor also failed to question the surgeon's assessment (since
nurses don't make medical diagnoses) and this unfortunate woman experienced
excruciating pain all night long only to expire in an untimely manner in the
wee hours of the morning, due to aspiration of coffee ground emesis and septic

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