Exam 11: Surgery of the Liver, Biliary Tract, Pancreas, and Spleen

What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy?

Marvin Townsend is a 29-year-old man with paraplegia caused by spinal cord injury from a diving accident 4 years ago.He is transported into the trauma ED after being hit by a car as he was crossing the street in his wheelchair.He has a possible rupture of his liver and is scheduled for surgery.The perioperative nurse,on response to the trauma call,meets him in the ED to conduct a preoperative assessment and prepare for his procedure.Marvin tells the nurse that he is latex-sensitive because he was told that as a spinal cord injured person he should always be considered latex-allergic.An appropriate risk reduction strategy for Marvin's latex sensitivity/allergy would be to:

Jan Stuyvesant,a perioperative nurse,was the scrub person during a robotic-assisted laparoscopic cholecystectomy.She locked the robotic endoscissor into the adaptor on the robotic arm and positioned the tip end into the trocar port in order for the surgeon to dissect the cystic duct and artery,while the surgical assistant placed the clips on the cystic duct and artery.As she reached across the sterile field to insert the cholangiocatheter through the port,the anesthesia provider accidentally made contact with the distal end of the catheter as he stood up to reach the monitor controls.The contaminated end of the catheter touched the endoscopic clip applier,the endoscissor connector that the surgeon was using,the glove of the assistant,and Jan's gown sleeve.The surgeon ordered everyone to change their gown and gloves and covered the port area with a sterile towel.What was the rationale for the surgeon to continue to dissect and not change his attire?

The recipient liver OR is arranged for a major laparotomy and vascular procedure with customized instruments,supplies,and sutures according to the transplant surgeon's preference.In addition to the general patient care accessories,equipment,and supplies needed for any large surgery,also included are intraoperative laboratory testing and an autotransfusion system.Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant.

Both Maryanne and Charles Rigler had surgery 6 days ago.Charles had a living-related donor liver transplant and Maryanne,the matched donor,provided a segment of her healthy liver for her husband.They have both recovered as expected and are preparing for discharge.They are concerned about who will be the primary caregiver,since they are both recovering at the same time and rate.They also realize that they will need clear and realistic instructions and support because of their unique situation.They are most concerned about incision care,side effects that could mean complications,nutrition,and activity restrictions and escalation.An appropriate risk reduction strategy for Maryanne and Charles would give first priority to (select all that apply):

The head of the pancreas is fixed to the:

Joanne Grizwald,a 24-year-old woman with type 1 diabetes who is in end-stage kidney failure,is scheduled for a combined kidney-pancreas transplant.She is relatively healthy and at normal weight for her height in spite of her disease process.Her bleeding time and coagulation parameters are within normal limits.The circulating nurse has set up the autotransfusion system,verified Joanne's blood type,and crossmatched blood availability.The scrub person,while organizing the sterile back table,identified several instruments that she will not need.She organizes those instruments on the most distant part of the back table.What instruments is the scrub person unlikely to need during this procedure?

During an emergent total open splenectomy on a patient with blunt force trauma to the abdomen,the circulating nurse and anesthesia provider noticed rust-colored urine in the urinary collection container.They had just hung the third unit of whole blood.What nursing action is the first priority?

The circulating nurse approaches the preoperative holding lounge to see her next patient,Alfred Neumann,a 57-year-old nurse newly diagnosed with pancreatic cancer.He had an ERCP 1 week ago and,based on the findings,was scheduled for surgery at the comprehensive cancer center,where he works in the interventional endoscopy unit.He is aware of the poor prognosis for this disease and his nurse has recorded his nursing diagnosis as:Anxiety related to impending surgical procedure,perioperative events,and surgical outcome.An appropriate nursing action for Alfred would be to:

Jarvin Patel,a 42-year-old woman from Mumbai,India,is visiting her daughter and new grandson.She is a devout follower of Hindu religious practices and has been diagnosed with splenomegaly,possibly from idiopathic thrombocytopenia.Jarvin is scheduled for a total splenectomy.During the preoperative assessment,the perioperative nurse,an observant Hindu herself,is concerned about the possibility of significant bleeding because of Jarvin's coagulopathy and the need for hemostatic agents that are typically used to stop bleeding.Many of these products are manufactured from bovine source products and it would be in conflict with Jarvin's religion to use products from a cow.An appropriate risk reduction strategy for selection of hemostatic agents that would not be in conflict with Jarvin's belief system would be:

An example of a potential risk associated with pneumoperitoneum would be:

The biliary system (also called the biliary tree)drains bile from the gallbladder to the ampulla of Vater.The primary function of the gallbladder is to:

An example of an indication for liver transplantation would be:

Matthew Ryan,a 9-year-old boy,is admitted to the emergency department for a sledding accident,when he lost control of his sled and crashed into a tree.He is pale and in pain;his abdomen is tender and firm to palpation.The CT scan suggests rupture of the spleen with internal bleeding.Matthew's scheduled surgery will most probably be a(n):

While the pancreas' function is carbohydrate metabolism with the production of insulin and digestive enzymes,the spleen's function is primarily ___ with the production of ___.

The donor liver OR is prepared for an open laparotomy procedure with basic laparotomy and vascular instruments and accessories.A second sterile instrument table is set up to receive and prepare the procured liver.Select the additional instruments and accessories needed on the donor organ preparation table.

Steven Morganstein,a 51-year-old male with hepatobiliary disease,is scheduled for surgery.The perioperative nurse,during the preoperative assessment,questions and examines the patient for signs and symptoms of jaundice,petechiae,and lethargy and:

Open common bile duct (CBD)exploration may be indicated in some cases where:

The liver is essential in the metabolism of carbohydrates,proteins,and fats,generating nutrient stores of which substance that supplies energy sources to the brain and body?

Number the sequence of critical steps for receiving,checking,and verifying the transplant organ. A.The organ arrives at the OR. B.The circulating nurse and a second RN verify the organ tag with the preliminary crossmatch report to ensure the following match:the recorded ABO type of the recipient is the same or is compatible with the recorded ABO type of the donor,the UNOS (United Network for Organ Sharing)number on the organ is the same as the UNOS number on the Preliminary Crossmatch Report.The two RNs then identify the patient according to hospital policy and sign the Transplant Verification form. C.The transplant surgeon verifies that the UNOS number on the Preliminary Crossmatch Report is the same as the UNOS number on either the organ container or the paperwork provided and verifies the compatibility of the organ and the patient by ABO blood type.The transplant surgeon signs the Transplant Verification form. D.The Transplant Verification form and Preliminary Crossmatch Report are placed on the permanent part of the patient's medical record. E.Crossmatch and ABO reports from the human leukocyte lab and blood bank are received. F.The Transplant Verification form (deceased donor)is attached to the record. G.Once the patient is taken into the OR,a time-out is taken with the OR team according to OR policy and procedure. H.The OR charge nurse verifies the recipient's preliminary crossmatch and ABO report. I.The circulating nurse identifies the box with a recipient patient label.