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OUTLINE OF PRESENTATION
1.
OBJECTIVE
2.
DEFINITION
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
OBJECTIVE
ANATOMY
DEFINITION OF LIPOMA
PATHOPHYSIOLOGY
Tumor cells are cells that have grown
autonomous transparmasi and last of
control normal cell growth until the cell is
different from a normal cell in the form
and structure.
Generally tumors began to grow from a
single cell somewhere (unisentrik) or
from some central (multilokuler) at the
same time.
During the growth of tumor is still
confined to the organ remains essentially
the tumor is referred to in local phase.
Inherited
Unknown
CAUSES
RISK FACTORS
Between 40 and
60 years old.
Having certain
other disorders.
Rare in children.
Adiposis dolorosa,
Madelung disease,
Cowden syndrome and
Gardner's syndrome
COMPLICATION
Lipomas under the skin
(subcutaneous) rarely cause
complications, but large nodules may
interfere with muscle function or may
cause nerve pain.
Lipomas occurring on a joint may limit
movement.
If they develop in the bowel, lipomas
can cause potentially serious
obstruction.
An
ultrasound
or other
imaging
test, MRI or
CT scan
INVESTIGATION
Physical
exam
TREATMENTS
SURGICAL REMOVAL
2. NON SURGICAL
Steroid injections. This treatment
shrinks the lipoma but usually doesn't
completely eliminate the tumor.
Liposuction. This treatment uses a
needle and a large syringe to remove
the fatty lump.
1.
Surgical removal.
Most lipomas are
removed surgically by
cutting them out.
PROCEDURE OF EXCISION
OF LIPOMA
Once freed,
the lipoma is
delivered as
a whole, and
hemostasis
is achieved.
Interrupted 3-0
Vicryl sutures are
used to partially
close the dead
space.
Skin closed with 4-0
nylon
Pressure dressing
placed to reduce
incidence of
hematoma formation.
PATIENT PARTICULAR
Patients name: Madam X
Age: 38 years old
IC No: 760204-13-XXXX
Reg. No : 2014/016520
Gender : Female
Patient electively admitted to the
female surgical ward on 26/05/2014
for excision of lipoma at the right
upper flank.
Previsiting
Present history
Right upper flank swelling x 6 years.
Progressively increase in size
Pain around the swelling sometime at
the back
No skin changes over swelling
No pus discharge
Fever accasionally whenever pain or
swelling.
o Social history
Non smoking
Non alchoholic
Married 20 years
3 children with normal
delivery.
o Menstrual history
Menarche at 14 years old
Regular no dysmenorhea
LMP 11/5/2014
o Medical
Nil
o Surgical
Nil
history
history
Operation consent
Anaesthesia consent
b) Holding bay
Check vital sign
and chart in the
SSSL form for
baseline data
Temperature inside
operation theatre must be
average of 18C to 22C.
Humidity -50% to 60%Air
conditioning is functioning
well with good HEPA filter
system to reduce the
numbers of airborne
organism in operating
room.
Air exchange - 15 to 25
per an hour.
Close the OR door all the
time for positive pressure.
Operation room
Induction room
Before
operation begins,
scrub nurse have to wear a
proper operating room attire.
Prepare
After
After
The
After
a)INITIAL COUNT
Count sponge and
instrument before
case start.
Count audibly &
clear with
circulating nurse.
b)SUBSEQUENT
COUNT(2nd count)
count before closing
cavity
Count all sponge,
sharps and
instrument added
during case.
C)FINAL COUNT
Count all sponge,
sharps and
instrument before
skin closing.
Inform surgeon
and document.
3. Inform circulating
nurse the type of
specimen and
examination to be
done.
4. Hand over the
specimen in aseptic
manner to avoid
contamination of the
instrument and
sterile field.
Check the
dressing/operative
site-sign of
bleeding.
Documentation.
If any problem
occur, or any
abnormalities on
vital sign inform
doctor immediately.
Discharged patient
as ordered by
anesthetist.
Pre-operative
Nursing
Diagnosis
Objectives
Nursing intervention
Knowledge
deficit
related to the
disease,
operation
and post
operative
complication.
Patient will
verbalize
feeling at
ease during
her stay.
Evaluation
Nursing
Diagnosis
Objective
Nursing Interventions
Evaluation
Patient understand
the process of the
disease after
further explanation
from the doctor.
Nursing
diagnosis
Objective
Nursing Intervention
Evaluation
Potential body
injury during
transfer and
transport.
Patient safe
from any
injury.
Intra-operative
Nursing
Diagnosis
Objective
Nursing intervention
Evaluation
1.Potential
hypothermia
due to cold
environment
and expose of
body cavity
and blood
loss
Patients
body
temperature
will be
maintained
at 36 C 37
C
Patients body
Check patient baseline
temperature before surgery and temperature within
normal range.
hourly if indicated.
Avoid unnecessary exposure
of patient,keep patient covered
with blanket.
Provide warming blanket
Prevent pooling of preparation
solution under the patient
Use warm solution for
washing.
Clean and dry patient
throughly and provide dry
sheets, gown and blanket for the
patient.
Nursing
Diagnosis
Objective
s
Nursing Intervention
Potential of
electrical
burns
related to
the use of
the Electro
Surgical
Unit
Evaluation
Nursing
Diagnosis
Objective
s
Nursing Intervention
Evaluation
No sign and
symptoms of burn at
the patients body in
the end of surgery.
Post-operative
Nursing
Objectives
Diagnosis
Nursing Intervention
Evaluation
Pain
related to
the
operation.
Patients painful
reduce after taken
the analgesic as
ordered by
anesthetist
provider.
Pain score 0 1
/10
Patient will
experience
minimal
pain.
Discharge summary
Patient discharge from ward at 11am
No complaint of pain made while
discharge
Patient on PCM 1gm QID and Tablet
Tramal 50mg TDS 5/7.
Wound inspection on D3,no need
STO.
TCA 2 months with trace HPE.
Health education
patient to do dressing
Makes sure patient use correct solution to
clean the wound area before applying
dressing.
If the wound still bleeding,ask pateint to see
the doctor immediately.
Ask
CONCLUSION
references
http://www.mayoclinic.org/diseasesconditions/lipoma/basics/definition/con
-20024646