Question

please help with this case study:

26-year-old Beth experiencing persistent abdominal pain. She recently traveled to South East Asia for vacation and thought it was probably the food she ate. Gl clinic found small ulcer in the stomach, can be repaired by simple surgical procedure through endoscope. Beth is obese, but generally healthy. She loves to eat different exotic food and frequent alcohol consumption. During the pre-op assessment, RN discovered that Beth is actually pregnant, estimating 26 weeks, and she was not aware. She is in high risk to deliver pre-maturely, since there was poor prenatal care. Please describe the following: 1) What result would you expect from patient pre-op assessment? Signs and symptoms, H&P, Labs. 2) What's the appropriate anesthesia care plan and intraoperative considerations? 3) How will you get ready for this surgical case? Equipment, Instrument, Monitoring devices 4) Describe Operating room setup for this case. 5)Describe roles and responsibilities of each Perioperative health care provider involved in the care of this patient (directly and indirectly)

Answer 1

1, Preoperative assessment result for stomach ulcer with 24 weeks pregnant women should include pain level, epigastric tenderness, and abdomen distension, general appearance, vital signs, height, and weight profile, nutrition status and pelvic examination it should include uterine size, fetal heart rate, fetal movement, maternal stress, and anxiety. lab test including hemoglobin, glucose screen, urine protein, and glucose, Rh titer and breathe test, ultrasound Abdomen and pelvis. history should include complication details like any bleeding, hypertension, and stress, etc.
2, surgical intervention should consider fetal risk and safety of the mother. the simple surgical procedure through endoscopy benefits patients when they pregnant as usual as nonpregnant time. the patient should be placed in lateral or partial decubitus positions to lower the compression of vena cava, they should change the position regularly. concern to use close access techniques important to avoid the risk. trocar placement should be altered, needles and equipment should be safely used. co2 insufflation of 10-15mmhg should be used for sufficient co2 exchange. use VTE prophylaxis to access fetal heart monitoring during the procedure. Preoxygenation 100% o2 for 3-5minutes should be considered. consider H2 blockers or sodium citrate to lower the risk of aspiration. avoid the heavy doses of NSAID drugs to avoid the risk of premature closure. a lower dose of regimens of LAs and opioids achieve the desired goals.
3, Equipment and monitoring devices for this surgical care need intra-operative co2 monitoring, VTE prophylaxis, cardiac monitoring, open technique, and continuous fetal heart monitoring, closed needle and optical access, use electrosurgical equipment and monitoring system should avoid potential complications.
4, Local anesthesia agent modified Hasson technique, open fascia technique should be setup. the patient position changes should be considered. monitor fetal heart rate and uterine contraction. surgical obstetrics with advanced techniques of endoscopy can avoid complications.