A small compilation of nurse anesthesia care plans
These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.
Nissen Fundoplication
Etiology
A Nissen procedure is used to treat GERD and hiatal hernia. The "fundus" (hence the term fundoplication) of the stomach, which is on the left of the esophagus and main portion of the stomach, is wrapped around the back of the esophagus - sutured together around the lower esophagus with nonabsorbable sutures Care must be taken not to injure the spleen or vagus nerves during the repair
Preoperative Considerations
Incision
Ports across the abdomen.
May use CO2 insufflation
Position
Supine
Surgery Time
1-2 hrs
EBL
50 mL
Inspect the spleen for bleeding before closure
Anesthetic considerations
RSI due to the risk of aspiration
Supine - decreased FRC, decreased HR, decreased venous return due to insufflation
Zone 3 in dorsal position
Alopecia
Risk of ulnar nerve damage - pad arms, less than 90 degrees
Check and pad pressure points
Be careful if using an esophageal stethoscope not to get it sutured in place