Presentation by Group 10 members RGN 111

Surgery and surgical nursing

1. PRESENTATION DONE BY GROUP 10 ON THE TOPIC FISTULA DISEASES AND ABNORMALITIES OF THE EYE

2. DEFINITION: A fistula is an abnormal connection or passageway that forms between two epithelialize surfaces, such as between two organs, between an organ and the skin, or between blood vessels. In simple terms: it’s a channel that shouldn’t normally exist, allowing fluid or other substances to pass where they are normally wouldn’t.

3. COMMON TYPES; Vaginal fistula: vaginal fistula  is an unusual opening that forms between the vagina and another organ, such as the bladder, colon or rectum. 

4. Anal fistula; Anal fistula also called FISTULA-In-Ano is is a tunnel that develops between the inside of the anus and the outside skin around the anus. 

5. Extrasphintric Fistula An extrasphintric fistula (≈5% of all anal fistulas) is a rare type in which the tract extends from the rectum to the perineum, coursing laterally around (outside) both the internal and external anal sphincter muscles, without crossing through them.

6. Urethra fistula; A  urethral fistula  is a linear outpouching of the urethra that reaches the skin surface

7. Enterovaginal fistula; An enterovaginal fistula is an abnormal communication between the intestine (small or large bowel) and the vagina.

8. Causes of fistula Surgical procedures Diverticular disease Injury due to trauma Inflammatory bowel disease Congenital Malignancy Miscellaneous (foreign bodies) Infections

9. General signs and symptoms of fistula Abnormal opening on the skin or near a body orifice Discharge from the opening (pus, stool, urine, blood, bile depending on site) Pain, swelling, or tenderness around the area Recurrent abscesses or boils Fever, malaise (if infection present) Irritation of surrounding skin (due to constant leakage)

10. Surgical management of fistula Fistulotomy – laying open the tract (most common for simple fistulas). Fistulectomy – complete excision of tract. Seton placement – for high fistulas to preserve sphincter function. Advancement flap procedures – closure of internal opening. LIFT procedure (Ligation of Intersphincteric Fistula Tract). Fibrin glue or plugs – minimally invasive options.

11. Nursing management for fistula Assess the site of fistula Control Infection Care for wound and skin Monitor fluid and electrolyte balance Provide nutritional support Manage pain Encourage psychological support

12. Complications of fistula Recurrent infections Sepsis Dehydration Ulceration Urinary or fecal incontinence

13. DISEASE AND ABNORMALITIES OF THE EYE

14. Cataracts; Definition; Cataract is the clouding of the eye normally clear lens which impairs vision by blocking light from reaching the retina.This cloudiness can lead to blur-dim or hazy visions,a yellowish tint to colours and difficulty seeing in the dark.

15. Causes of cataract; Primary is cause by the natural aging process buy can also result in factors like Diabetes Prolong exposure to UV light Excessive alcohol consumption Long term use of corticosteroids medication Eye injury or trauma.

16. Sign and symptoms of cataract: Vision is cloudy or blurry Colors look faded You cant see well at night Lamp,sunlight or headlights seem too bright You see a halo around light .

17. Surgical management : The surgical management of a cataract involves removing the cloudy natural lens and replacing it with a clear ,artificial intraocular lens (IOL).

18. Nursing management; Encourage pre operative education and post operative care Administer pre operative drops for pupil dilation Ensure patient safety by managing risk for falls Monitor complications like redness Provide emotional support

19. Complications of cataract Total blindness Increases eye pressure Retinal detachment Inflammation or infection( Endophtalmitis )

20. Pterygium of the eye Ptyriygium is a noncancerous, wedge-shaped, wing-like growth of the conjunctiva (the clear membrane on the white of the eye) that grows onto the cornea (the clear front part of the eye). Also known as surfer's eye, .

21. Causes of pterygium Prolonged exposure to ultraviolet light Chronic eye irritation Dusty environment Genetic predisposition Chronic ocular surface inflammation Male and older age are at risk.

22. Signs and symptoms Triangular shape fleshy growth Redness Decreased corneal transparency Foreign body sensation Blurred vision Itching

23. Surgical management; Surgical management for pterygium involves  excision of the abnormal conjunctival growth, typically followed by covering the defect with a conjunctival autograft (the gold standard) or an amniotic membrane graft to prevent. Also removal of the abnormal tissue from the sclera and cornea of the eye .

24. Nursing management; Assess the eye if there is ,redness ,eye irritation ,foreign body sensation or tearing or blurred vision . Educate the patient on the importance of wearing sunglasses and hats to protect the eyes from U.V light ,which can slow growth and help prevent recurrence . Emphasize the importance of hand washing before touching the eye area and instruct on gentle ways to clean around the eye such as using a saline-moistened cotton ball . Administer prescribe medication Pain management Follow up

25. Complications; Astigmatism Blurred vision Restriction of ocular movement Recurrence after surgery Corneal scarring

26. GLAUCOMA; What is glaucoma? Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve. 

27. PATHOPHYSIOLOGY The eye contains a fluid called AQUEOUS HUMOR that needs to drain out through a drainage angle .If this drainage system is not working properly ,the fluid can build up ,increasing eye pressure . This increased pressure can damage the optic nerve ,which connects the eye to the brain . Damage to the optic nerve can lead to gradual vision loss .

28. RISK FACTORS Age Genetics Medical conditions Eye injuries Medications Race

29. Sign and symptoms Loss of peripheral (side ) vision Blurry vision Seeing halos around lights Mild eye pain or redness Headache Nausea and vomiting Pupil that does not respond to light normally

30. SURGICAL MANAGEMENT This involves creating new drainage channels for the eye’s fluid to reduce intraocular pressure ,with common procedures including trabeculectomy and glaucoma drainage implant surgery. Canaloplasty can be done by using a microcatheter to enlarge the eye’s natural drainage canal to improve fluid outflow .

31. NURSING MANAGEMENT OF GLAUCOMA Assess for intraocular pressure and observe for symptoms . Administration of medication Patient education Psychosocial support Prevention and screening Post-OP care

32. COMPLICATIONS Vision loss and blindness Hypotony Suprachoroidal haemorrhage