Attendance of pre-operative counseling and explanation of procedure to patient
3
Approval: Surgeon for surgical planning
4
Ensure all required surgical equipment and instruments are available
5
Preparation of the patient for surgery, including anesthesia induction
6
Perform the Nissen Fundoplication procedure (creation of a gastric wrap)
7
Ensure the wrap is in its correct position and no damage has occurred to any organs
8
Final surgical wound closure after checking the operative site
9
Transfer patient to recovery unit
10
Monitor patient's vital signs in the recovery unit
11
Administer pain management to the patient as necessary
12
Progress assessment of patient's recovery
13
Approval: Surgeon for removal of tubes/catheters
14
Provide post-operative care instructions and discharge patient
15
Schedule follow-up appointment for patient
16
Ensure proper reporting and documentation of the procedure
Complete pre-operative assessments
Conduct a thorough assessment of the patient's pre-operative condition to ensure their readiness for the Nissen Fundoplication procedure. This includes evaluating their medical history, conducting physical examinations, reviewing test results, and assessing any potential risks or complications. The information gathered during this process will guide the overall surgical plan.
1
Food
2
Medications
3
Environmental
4
None
1
Normal
2
Abnormal
1
Cardiovascular
2
Respiratory
3
Gastrointestinal
4
Neurological
5
Musculoskeletal
Attendance of pre-operative counseling and explanation of procedure to patient
Schedule a pre-operative counseling session with the patient to provide them with all the necessary information regarding the Nissen Fundoplication procedure. Use this opportunity to address their concerns, explain the surgical steps, discuss potential risks or complications, and ensure their informed consent.
Approval: Surgeon for surgical planning
Will be submitted for approval:
Complete pre-operative assessments
Will be submitted
Attendance of pre-operative counseling and explanation of procedure to patient
Will be submitted
Ensure all required surgical equipment and instruments are available
Verify the availability, functionality, and sterility of all the equipment and instruments required for the Nissen Fundoplication procedure. Ensure the inventory is complete, properly organized, and ready for use in the operating room.
1
Forceps
2
Scalpel
3
Trocar
4
Retractors
5
Sutures
Preparation of the patient for surgery, including anesthesia induction
Prepare the patient for the Nissen Fundoplication procedure by providing pre-operative instructions, ensuring proper fasting, verifying consent forms, and administering anesthesia for induction. Coordinate with the anesthesiologist to ensure a smooth and safe transition to the operating room.
1
General anesthesia
2
Regional anesthesia
3
Local anesthesia
1
Fasting requirements
2
Medication restrictions
3
Shower protocol
4
Dressing instructions
Perform the Nissen Fundoplication procedure (creation of a gastric wrap)
Perform the Nissen Fundoplication procedure by creating a gastric wrap around the lower part of the esophagus to strengthen the lower esophageal sphincter and prevent acid reflux. Utilize the appropriate surgical techniques, instruments, and sutures to ensure a successful procedure.
1
Open surgery
2
Laparoscopic surgery
3
Robotic-assisted surgery
1
Mobilization of the stomach
2
Dissection of the esophageal hiatus
3
Gastric wrapping
4
Suturing
Ensure the wrap is in its correct position and no damage has occurred to any organs
Conduct a thorough assessment after the Nissen Fundoplication procedure to ensure that the gastric wrap is properly positioned and intact. Verify the absence of any damage or injury to adjacent organs, such as the stomach, liver, or diaphragm. Address any concerns or complications promptly.
1
Properly positioned
2
Malpositioned
1
Stomach
2
Liver
3
Diaphragm
4
None
Final surgical wound closure after checking the operative site
Close the surgical incisions after careful inspection of the operative site to ensure proper closure and minimize the risk of infection or complications. Utilize appropriate closure techniques, such as sutures, staples, or adhesive strips, based on the patient's condition and the surgeon's preference.
1
Sutures
2
Staples
3
Adhesive strips
1
Vertical
2
Transverse
3
Midline
4
Laparoscopic ports
Transfer patient to recovery unit
Safely transfer the patient from the operating room to the recovery unit. Coordinate with the nursing staff to ensure a smooth transition and continuity of care. Provide necessary information about the patient's condition, medications, vital signs, and any specific post-operative instructions.
1
Vital signs documentation
2
Medication reconciliation
3
Patient identification
4
Wound assessment
Monitor patient's vital signs in the recovery unit
Continuously monitor the patient's vital signs in the recovery unit to ensure their stability and detect any signs of complications or distress. Regularly record and review the patient's blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature.
1
Blood pressure
2
Heart rate
3
Respiratory rate
4
Oxygen saturation
5
Temperature
Administer pain management to the patient as necessary
Assess and manage the patient's pain in the recovery unit based on their individual needs and the surgeon's recommendations. Utilize appropriate pain management strategies, such as analgesic medications, non-pharmacological interventions, or patient-controlled analgesia (PCA) devices.
1
Visual Analog Scale (VAS)
2
Numeric Rating Scale (NRS)
3
Face Pain Scale
1
Medications
2
Non-pharmacological interventions
3
PCA device
Progress assessment of patient's recovery
Regularly evaluate the patient's progress in their recovery from the Nissen Fundoplication procedure. Assess their overall condition, wound healing, pain level, ability to tolerate oral intake, and readiness for discharge. Collaborate with the healthcare team to determine the appropriate plan for the patient's post-operative care.
1
Good
2
Delayed
3
Infection
1
Oral intake tolerance
2
Mobility
3
Pain control
4
Bowel movement
Approval: Surgeon for removal of tubes/catheters
Will be submitted for approval:
Progress assessment of patient's recovery
Will be submitted
Provide post-operative care instructions and discharge patient
Educate the patient and their caregivers about the post-operative care requirements following the Nissen Fundoplication procedure. Provide clear instructions regarding wound care, medication management, dietary guidelines, activity restrictions, and signs or symptoms that require immediate medical attention. Ensure the patient understands and is prepared for their recovery journey at home.
1
Medication prescriptions
2
Dietary guidelines
3
Follow-up appointment schedule
4
Emergency contact information
Schedule follow-up appointment for patient
Arrange a follow-up appointment for the patient to monitor their recovery progress, review the surgical outcome, address any post-operative concerns or complications, and provide further guidance or referrals as necessary. Coordinate with the healthcare team to schedule the appointment at an appropriate time frame.
1
Post-operative assessment
2
Suture removal
3
Test results review
4
Complication management
Ensure proper reporting and documentation of the procedure
Accurately report and document all relevant details of the Nissen Fundoplication procedure for proper record-keeping, research purposes, and continuity of patient care. Include information about the surgical technique used, procedural steps, findings, post-operative instructions, patient condition, and any complications or unexpected events.
