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[laparo- + -tomy]
The surgical opening of the abdomen.
SYN: SEE: celiotomy
Preoperative: The patient's knowledge of the surgery is determined, misconceptions clarified, and a signed informed consent form is obtained. A baseline assessment of all body systems is conducted. The patient is encouraged to express feelings and concerns, and reassurance is offered. Preoperative teaching should focus on explaining the procedure, postoperative care, and expected sensations. Preoperative blood tests (including complete blood counts and serum chemistries), urinalysis, ECG, and chest X-ray usually are carried out, and consultations with appropriate specialists are conducted. Physical preparation of the patient is carried out according to protocol regarding diet; removal of abdomen and pubic area hair; enemas, douches, administration of intravenous fluids, measurements of vital signs and intake and output. Antiembolic measures are applied as prescribed.
Postoperative: Vital signs and dressing status are monitored; the latter includes checking any drains in place and for the presence of vaginal bleeding if applicable. Ventilatory status is assessed by auscultating for adventitious or decreased breath sounds, and respiratory toilet (deep breathing, coughing, incentive spirometry, oral hygiene, and repositioning) is provided as determined by the patient's response. The nurse assists the patient to use noninvasive pain relief measures and prescribed analgesia for pain relief or monitors patient-controlled analgesia for effectiveness. Fluid balance is monitored, and prescribed fluid and electrolyte replacement therapy is administered. The patient is encouraged to void after surgery; the bladder assessed for distention, which may indicate urinary retention; and catheterization is instituted only when nursing measures are unsuccessful. The abdomen is auscultated for the return of bowel sounds, and a high-protein, high vitamin C diet is initiated following clear to full liquids as prescribed. Leg mobilization, turning, and early ambulation are encouraged, to promote gastrointestinal activity and prevent venous thrombosis. The hospital staff initiates early discharge planning, which includes carrying out patient teaching focused on incisional care, obtaining adequate nutrition, complications to report, e.g., nausea, vomiting, fevers, chills, constipation or wound dehiscence, and activity resumption and restrictions; arranging referral for home care as appropriate; and ensuring that the patient has scheduled (and plans to keep) a follow-up appointment with the surgeon.