Lunan Yan (ed.)Operative Techniques in Liver Resection10.1007/978-94-017-7411-6_9

9. The Key Points of Postoperative Monitoring and Nursing Care

Yanli Luo¹ and Peixian Chen¹

(1)

Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China

Yanli Luo

Email: luoyl6@126.com

9.1 Preoperative Nursing Care

9.1.1 Preoperative Workup

History

Background: age, sex, marital status, and occupation

Etiology and predisposing factors: hepatitis, cirrhosis, diet and lifestyle habits such as intake of aflatoxin-containing food or exposure to carcinogenic nitrosamines, and liver cancer or other malignancies in family members

Past history and comorbidities: history of surgeries, medications, allergies, neoplasms involving other sites, and miscellaneous comorbidities

Assessment of symptoms and signs [1]

Pain: pain in the region of the liver is the most common symptom (inquiry about the timing, location, predisposing factors, level, and other characteristics of the pain as well as any associated symptoms). Attention should be paid when acute excruciating epigastric pain occurs, as this symptom is likely to indicate intra-abdominal hemorrhage due to rupture of a hepatic carcinoma.

GI symptoms: poor appetite, abdominal distention, nausea, vomiting, diarrhea, etc.

Systemic symptoms: weakness, progressive weight loss, continued low-grade fever, or intermittent fever of unknown causes.

Other symptoms: anemia, jaundice, ascites, edema of the lower extremities, subcutaneous hemorrhage, etc.

Laboratory and radiologic findings

Laboratory results: AFP, ferritin, CEA, CA19-9, serum enzymology indicators, liver function tests, hepatitis virus markers, and HBV DNA copies

Radiologic findings: abdominal Doppler, CT, and MRI

Psychological and social well-being

Do patients and their family adequately understand the nature of the planned procedure? Do they adequately understand possible consequences of the disease and how to recover promptly from surgery?

Are the patients and their family afraid or worried about the procedure and the potential bad outcomes and complications that may occur during and after the operation? Can they face these possibilities?

Is the treatment financially affordable for the patients?

9.1.2 Preoperative Nursing Care

Psychological: Anxiety, depression, loneliness, anger, sadness, and helplessness are the commonest psychological problems occurring in patients after hepatectomy. We should carefully evaluate the mental well-being and family/social background of the patients and then offer tailored psychological nursing care, such as confidence therapy, comfort therapy, etc. Strengthening exchanges with patients are also important. In this way, patients can acquire information about the hepatectomy, build up self-confidence, and maintain optimism.

Improve the function of critical organs: Assist patients in completing the preoperative examination in order to gather information about the condition of critical organs like the heart, lung, brain, and kidney. Measures should be taken to treat underlying comorbidities in order to avoid perioperative complications. In the case of preoperative respiratory infections, surgery can be considered only after the infection is treated with antibiotics and nebulized medications.

Correct coagulation disorders: Cirrhotic patients are susceptible to hemorrhage because of inadequate synthesis of coagulation factors by the liver or thrombocytopenia due to splenomegaly. To lower the risk of massive perioperative hemorrhage, administration of intravenous or intramuscular vitamin K prior to the operation can be considered in specific cases, based on the procoagulation time, prothrombin time, and blood platelet count.

Hepatic support therapy: This should be individualized. Liver-protective drugs should be given to patients with deteriorating liver function, and albumin should be given to patients with hypoalbuminemia. For patients with impaired liver function and ascites, the intake of water and sodium should be strictly controlled; the 24-h intake and output volumes of liquid, body weight, and abdominal circumference should be closely monitored and accurately recorded on a daily basis.

Improve nutritional condition: An easily digested diet rich in protein, calorie, and fiber, with low fat and low residue, is encouraged preoperatively. To improve patients’ nutritional condition and tolerance of the operation, patients should be encouraged to eat independently and given parenteral nutritional support when they are unable to eat.

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