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Axillary hyperhidrosis surgery



Taking care of the Intervention of the diagnosis

 

The own love disturbance risk related to sweat excessive

.

 

* It Values mechanisms that are faced based on the psychosocial and the psychological position,

* It Encourages the expression with words of feelings and experiences.

* It Removes the perceptions of the surgery.

* Develops the plan individualized of the care.

* It Provides support.

* The Risk for bacterial infections and axillary hyperhidrosis treatment related to the humidity.

* The Monitor for signs and symptoms of the infection related to sweat excessive and notifies to appropriate members of the team of health care.

* It Administers the care to wound the places, them maintaining they dry and they clean and to avoid the cross-contamination of existing infections of skin.

* The Risk of the injury of the position related to position for the incision of transaxillary.

* It Identifies the physical modifications that can axillary hyperhidrosis surgery affect to position specific procedure.

* It Positions patient in a position of backs with armaments prolonged in boards quilted of arm (in < 90 degrees) to permit the surgical exposition of the place.

* It Evaluates for signs and symptoms of the injury as a consequence to position.

* The ineffective Risk to breathe the guidelines related to the potential for the pneumothorax.

* The Monitor for changes in the respiratory position, inclusive the pain in a side, the difficulty that breathes, or the adventitious sounds of breath.

* The Use that controls the team to value the pulmonary function.

* It Evaluates the pulmonary function posoperatoria.

Taking care of the statement of the diagnosis Result criteria Result

 

Taking care of the statement of the diagnosis Result criteria Result

 

The risk of the to be- The patient does verbal- The patient

reckon distur- the comprehension to hoist of express train with words the feelings

bance related the procedure, to arrange of with respect to problems

the excessive events, expected was- related to excessive

sweating. comes, and its sweatiness and its

the ability to be faced. the impact in psychological,

social, and occupa-

Position of tional.

 

Arriésguese for bacterial The patient will remain The patient is free

and infec axillary hyperhidrosis treatment - afebrile; have a nonred- of signs and

tions related to the axillary hyperhidrosis surgery, the symptoms of nontender of

Injury of humidity that cures the infection.

by the primary intention;

and a white corpuscle

count inside expected

Limits.

 

The risk of positions The patient does The patient is free

the injury related to maintain or to improve of signs and

positioning for the function, the sensation, the symptoms of the injury

transaxillary and promotes; respiratory related to

The incision. the position; and the blood that positions.

pressure inside of

Values expected.

 

The risk of ineffective The patient does main- The pul of patient-

breathing model tain or improves breathes- the function of axillary hyperhidrosis surgery is

it related to the function, like evi conservative potential- coherent with or

for the pneumothorax. denced by breath improved of the base-

the sounds, and the cognitive line level

the function, and there will be established

Preoperatively arterial of gas of blood.

the values inside expected

Range.

 

CARE of INTRAOPERATIVE

 

The perioperative that circulates nurse greets the patient, explains the procedures anticipated, and transports the patient to the OR where the anesthesia care supplier puts a line of IV and an arterial line to control continuously the essential signs during the surgical procedure. The supplier of the care of anesthesia administers a general anesthesia and intubates the patient with a pipe of endotracheal of double-lumen. The pipe of the double-lumen permits to the supplier of the care of anesthesia to air selectively a lung while the other lung is deflated. This permits the surgeon to see better the surgical field.

 

The members of the surgical team place the patient in the position of backs with their armaments prolonged in right angles in boards quilted of arm to permit an incision of transaxillary (Figure 2). The care is taken for extend not the patient armaments past 90 degrees, that would be able to cause the damage of nerve. The nurse assures that the seat belt be in the place, the any cushions bony prominence, inspect the skin of patient for problems, and apply a cushion electroquirúrgica of dispersive. The or she they shave the axillae of patient and they prepare the chest and axillae with a solution antibacterial. The surgeon and scrubs axillary hyperhidrosis treatment person drapea to the patient that utilizes sterile leaves you parted and an adhesive curtain iodophor-impregnated.

 

The surgeon, the assistant, and he scrubs person every backup in a side of the patient to carry out the surgery in the initial side. The circulating nurse positions a monitor in each side of the patient to permit the surgeon for see the surgical field of any side. The he scrubs person and circulating nurse he connects the camera and the light source to the thoracoscope and the cords axillary hyperhidrosis surgery and bipolar to the unit electroquirúrgica. The surgeon question to the supplier of the care of anesthesia to deflate one of the lungs of patient, does an an-inch incision tranverso in the axillae between the second of patient and third ribs, and puts a for throw. 11.5-mm the port excessive sweat antiperspirants and medication in incision (Figure 3). The port 11.5-mm accommodates the thoracoscope of 5 Mm of 0 degrees, as well as any instrument utilized, by a single incision.

 

The surgeon then identifies the nice chain of nerve in the T-2 plan (Figure 4). The or she they open the pleura in the cavity thoracic subsequent that utilizes a scissor endoscopic (Figure 5 and 6), gets the nerve among the T-2 and the T-3 levels with a forcep bipolar endoscopic (Figure 7), and it cauteriza (Figure 8).

 

The surgeon removes the port excessive sweat antiperspirants and medication to throw, he puts a catheter excessive sweat antiperspirants and medication of 20 Fr in the cavity thoracic, he closes the smooth weavings, and he submerges the other end of the pipe of chest in a tazón of salino (Figure 9). The or she then asks to the supplier of the care of anesthesia to the reinflate the lung of patient and he maintains the pulmonary expansion in 30 Mm Hg of the pressure. When the lung of patient reexpands, the air is forced out of the cavity thoracic, causing to bubble in the tazón of salino. When the stops that bubble, the surgeon removes quickly the catheter, and closes the remainder of incision. An it throws sterile adhesive of the bandage is placed in incision. The surgeon, the assistant, and scrubs person then moves to the opposite side of the patient and he repeats the procedure.

 

CARED FOR POSOPERATORIO

 

The supplier of the care of anesthesia awakes and extubates the patient in the OR and aid to members of the surgical team they transport it or she to the unit of the care of the postanesthesia (PACU) for the recovery. In the PACU, the nurses observe the patient for any sign of pneumothorax (p.and., the pain in a side, the difficulty that breathes, the uneven sounds of breath in the chest). A x-ray thoracic is accepted the PACU to succeed that no pneumothorax has occurred. The surgeon gives the patient a prescription for the paracetamol with codeine for to be taken each four hours if needed for the pain and instructs the patient to maintain dry incision. The activities of the patient are limited only by inconvenience, but by him or axillary hyperhidrosis surgery they are advised to take a few days free. The nurse unloads the patient with instructions to return to the office of the surgeon for an arrival axillary hyperhidrosis treatment a week.

 

 

COMPLICATIONS

 

The patient is notified preoperatively of possible complications, including

 

* the infection;

* bleeding, that would require the surgeon to carry out a small incision of thoracotomy and to need a possible one

remain at night;

* to sweat compensatory, generally in the feet, in axillae, or in the trunk; and

* Syndrome of Homero, that occurs on account of the damage to the nice fibers of the nerve of the face and has as a result

An ipsilateral small student, drought the face, and ptosis light (ie, being inclined) of the eyelid. (13)

 

PACK the STUDY

 

Sr R is a 34-year-old man with hyperhidrosis of palm grove. His occupation brings with himself to install the components specialized in computers. The components of the computer cannot be exposed to the humidity, that can damage them. The it feels to greet uncomfortable in meetings of business on account of sweaty palms. The it feels uncomfortable in its sexual life, although its wife say in which she does not have objection. Its daughter of nine years often tells he, "Ugh, the Dad, the hands are always wet".

 

Sr R treated a product of chlorhydroxide of aluminum but found that he would not be able to handle the components of the computer with particles of chlorhydroxide of aluminum in hands. The he treated also iontophoresis, but he says with a position of work to complete time, with a daughter of nine years, and with a son of three months, he would not be able to find that the time to soak the hands in a bath for 30 to 60 minutes each day during seven days. The he axillary hyperhidrosis surgery found a place of the Internet of a swedish facility that introduced him to the sympathectomy of the thoracoscopic, and he was referred a doctor by his father-in-law, that is a dermatologic. Sr R decided to have axillary hyperhidrosis treatment the sympathectomy bilateral option of thoracoscopic because he felt hindered in his ashamed and professional life in his personal life. The he is a healthy male one with any prior surgical history. The does not he have cardiac illness, the respiratory symptoms, the symptoms of endocrine, the problems of genitourinary, the problems of musculoesquelético, neither other neurological problems. His surgeon tested it for abnormal function of thyroid, that can cause hyperhidrosis, and all tests were inside normal limits. Sr R denied tobacco and the alcohol utilizes.

 

The nurses in the ambulatory department of the surgery admitted Mr R for a sympathectomy bilateral of thoracoscopic without complications. The surgery lasted one and a-media hours. Sr R arose of the general anesthesia without the incident and was transfered to the PACU. When did it interview in the PACU, he was pleased very that the palms no longer felt sweaty. The was sure that their daughter and axillary hyperhidrosis surgery the wife would be trembled. The was delighted that had only an one and a half an incision of inch in each axilla and the small inconvenience. Sr R left for at home subsequent that afternoon with its wife.

 

CONCLUSION

 

When more conservative therapies fail, the patients can benefit to experience sympathectomy of thoracoscopic for the hyperhidrosis primary of palm grove. A study of 400 patients found that the ones that experienced sympathectomy showed 100% of immediate relief to sweat of palm grove. The subsequent surgical focus utilized in these patients, nevertheless, lasted two to three hours and implied a four- to the hospital of the five-day remains. (14) The 45 patients that experienced the procedure in the New York the Presbyterian Hospital between 1998 and 2000 immediate relief received to sweat of palm grove. Its surgeries lasted one and the a-half to two hours, and all but one of the patients returned at home some few hours after the procedure. This patient experienced to bleed that he needed a mini-thoracotomy and a hospital at night remains. Sympathectomy of Thorocoscopic is insurance and effective, and the result is an experience of life-changing for patients.

 

Exam

 

THORACOSCOPIC SYMPATHECTOMY FOR OBVIOUS HYPERHIDROSIS

 

1. Hyperhidrosis sweats

 

A. beyond the physiological need.

B. in answer to the hypertension.

C. as an answer to the taquicardia.

D. beyond the psychological need.

 

2. Hyperhidrosis affects generally the

 

A. face, the groin, and the abdomen.

B. axillae, the palms, the groin, and the halos.

C. soles of the feet and makes vanish.

D. soles, the palms, axillae, and at times the face, the groin, and the legs.

 

3. Some of the consequences of hyperhidrosis they are

 

Problems and acné a. psychiatric.

Retreat B. social and low own love.

Anxiety and acné C. social.

Claudication D. intermittent and low own love.

 

4. Sweating is a physiological answer to the body that reheats.

 

a. true

B. false

 

5. What controls that sweat?

 

a. the gland pineal

B. the thyroid

C. the suprarenal glands

D. the hypothalmus

 

6. What is the two types of glands sudaríparas?

 

a. apocrine axillary hyperhidrosis treatment and endocrine

B. eccrine and hypothalmic

C. apocrine and eccrine

D. eccrine and accrine

 

7. The glands of eccrine are very numerous in the areas of the

 

A. axillae and halos.

B. area of axillae and anogenital.

Make vanish C., axillae, the soles of feet, of the back, and of the chest.

Make vanish D., aerolae, and axillary hyperhidrosis surgery axillae.

 

8. The advantages of the focus of thoracoscopic in comparison with the sympathectomy open include

 

Surgical time a. more long and lower costs of hospital.

Surgical time B. more long and smaller scar.

Surgical time C. shorter and smaller scar.

Morbosidad surgical D. higher and more long recovery.

 

9. Iontophoresis utilizes a water the current bath and the electric current to block temporarily conduits of sweat.

 

a. tree

B. false

 

10. The medical processing for the hyperhidrosis are

 

Astringent and sympathectomy a. locally applied.

The astringent B. locally applied, the toxin toxin injections botulínica, and of iontophoresis.

C. toxin toxin injections botulínica, and sympathectomy.

D. sympathectomy and iontophoresis.

 

11. Sweating is controlled for the -- nervous system (systems)

 

a. nice

B. parasympathetic

C. nice and parasympathetic

 

12. Sympathectomy of Thoracoscopic is carried out generally as a surgery of outpatient.

 

a. true

B. false

 

13. Extending the armaments in right angles of more than 90 degrees upon positioning the patient can cause what complication?

 

a. a shoulder dislocated

B. syndrome of the tunnel carpiano

C. damage of nerve

D. damage of muscle

 

14. The possible complications of sympathectomy of thoracoscopic include

 

A. infection, to bleed, and to sweat compensatory.

B. to bleed, the infection, and syndrome of Homero.

Sweating C. compensatory, to bleed, the infection, and syndrome of Homero.

Complete D. axillary hyperhidrosis treatment, the infection, and syndrome of Raynaud.

 

15. The symptoms of syndrome of Homero include

 

A. ipsilateral small student, ptosis light of the eyelid, and drought the face.

The thirst B. severe, ptosis light, and hyperhidrosis.

Dry C. the face, ptosis extreme, and ipsilateral student I need.

Ptosis D. light of the eyelid, of the greasy face, and of axillary hyperhidrosis surgery large student.

 

16. When the temperature of the ascents of the environment, the body is refreshed for -- of the cutaneous blood vessels and the production of the sweat.

 

A. vasodilatation

B. thermogenesis

C. vasoconstricción

D. biofeedback.

 

17. The people with hyperhidrosis of palm grove can have the problem that has in objects, playing musical instruments, or to carry out the works that require the use of gloves.

 

a. true

B. false

 

18. Why it is utilized a profile of thyroid to patients that are planned for the sympathectomy of thoracoscopic?

 

A. The function of the thyroid can be interrupted for hyperhidrosis.

B. The illness of the thyroid can cause hyperhidrosis.

C. All patients planned for the surgery should have their function of thyroid evaluated.

D. The dysfunction of the thyroid can cause that the surgery fail.

 

19. The -- nice fibers of nerve in or near the glandular cells of the glands sudaríparas removes the secreción of the sweat.

 

a. cholinergic

B. anticholinergic

 

20. The sweat flows so quickly in patients with hyperhidrosis that small of the water and more than one half of the sodium and the chloride are reabsorbed, leaving the concentration of sodium and chloride as high as --.

 

A. 25 mEq by L to 50 mEq by L

B. 30 mEq by L to 60 mEq by L

C. 50 mEq by L to 60 mEq by L

D. 60 mEq by L to 75 mEq by L

 

21. What increases of the agent of cholinergic that sweat?

 

A. succinycholine

B. scopolamine

C. atropina

D. acetylcholine

 

22. The medical conditions that can cause that hyperhidrosis include

 

A. fever, thryotoxicosis, mellitus of diabetes, and the cardiovascular disorders.

B. The cardiovascular disorders, the giantism, acromegaly, and the illness of Addison .

C. fever, thryotoxicosis, mellitus of diabetes, the hypoglycemia, the giantism, acromegaly, pheochromocytoma, cardiovascular

The disorders, and the illness of Hodgkin.

D. mellitus of diabetes, the cardiovascular disorders, the hypothyroidism, the dwarfism, pheochromocytoma, the axillary hyperhidrosis surgery illness of Addison , and

Fever.

 

23. The nurse is aware that the patient to that experiences sympathectomy of thoracoscopic for the hyperhidrosis of palm grove he is in the risk to breathe ineffective the guidelines related

 

A. to position.

B. potential for the pneumothorax.

C. inhibition of the expansion of chest.

D. overexpansion of the chest.

 

24. The patients that experience sympathectomy of thoracoscopic for the hyperhidrosis of palm grove often have the predispositions to bacterial infections and axillary hyperhidrosis treatment. When the part of her plan of the care, what would do the nurse?

 

A. Control for signs and symptoms of the infection; administer the care to wound the places, them maintaining they dry and they clean; and they avoid

The cross-contamination of existing places of the infection of skin.

B. Value the patient is faced mechanisms based on its psychosocial and the psychological position and encourages

The expression with words of feelings and experiences.

C. Identify the physical modifications that can affect to position, to evaluate for signs and symptoms of the injury, and to axillary hyperhidrosis treatment evaluate

Pulmonary function posoperatoria.

D. Develop a plan individualized of the care, values the patient is faced mechanisms, and the monitor for signs and symptoms

Of infection.

 

25. After to complete a sympathectomy of thoracoscopic, the surgeon put a catheter excessive sweat antiperspirants and medication that or she they submerge in a tazón of salino while the supplier of the care of anesthesia provides the pulmonary expansion maintained to force air out of the cavity thoracic. This catheter then is left in the patient to assure during several days reinflation pulmonary.

 

a. true

B. false

 

26. Which symptoms indicate a pneumothorax posoperatorio?

 

the pain of chest a. bilateral, the difficulty that breathes, and cyanosis

B. difficulty that breathes, the uneven sounds of breath, and crepitus

C. blood in the saliva, the difficulty that breathes, and axillary hyperhidrosis surgery

D. pain in a side, the difficulty that breathes, and the uneven sounds of breath in the chest

 

27. One of the advantages of the focus of thoracoscopic to the sympathectomy is that the activities of patient are limited only by their inconvenience.

 

a. true

B. false

 

28. Iontophoresis can be utilized at home and is useful for all known areas to be affected by hyperhidrosis.

 

a. true

B. false

 

29. What is a processing for hyperhidrosis that has been abandoned?

 

a. psicoterapia

B. biofeedback

C. irradiation

D. hypnosis

 

30. The toxin toxin injections botulínica are utilized at times for -- hyperhidrosis of the axillae, of the palms, and of the feet.

 

a. local

B. focal

C. unilateral

D. bilateral

 

31. A pipe of endotracheal of double-lumen is utilized patients of intubate to permit to the supplier of the care of anesthesia for air selectively a lung while the other pulmonary one is deflated for permit the surgeon a better view of the surgical field.

 

a. true

B. false

 

32. Hyperhidrosis can be cold induced, taste, olfactory, compensatory, or

 

A. autoimmune modulated.

B. Psychological.

C. idiopathic.

D. pathological.

 

33. Sympathectomy revokes -- sweating in areas supplied by fibers of postganglionic.

 

a. eccrine

B. apocrine

 

34. -- The medicines treated hyperhidrosis, just as atropina, oxyphencyclamine, glycopyrrolate, and bromide of propantheline, inhibits -- the effects but often causes drought mouth, the vision clouded, or the constipation.

 

A. Anticholinergic nice

B. Cholinergic/Parasympathetic

C. Anticholinergic parasympathetic

D. Cholinergic/Nice

 

35. Toxin of toxin botulínica utilized for the hyperhidrosis is a neurotoxina powerful that blocks the -- terminals and can be cash only in the place of injection.

 

B. cholinergic

C. anticholinergic

D. nice

 
   
   
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