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Age: 39 year-old.
Marital status: Married.
Left tendoachilles pain for 5 years.
Patient rates pain to 10/10. Patient said she had a Platelet-Rich Plasma
(PRP) injection 2 years ago as a treatment intervention for this condition and had some relief but over time, the pain came back and got worse.
Name of surgical procedure:
Endoscopic Gastrocnemius Recession.
Left leg Gastrocnemius Recession. This procedure is to release a tight calf muscle that is pulling the heel upward. To improve ROM(Range Of Motion), the tendon connecting to the tight calf muscle will be cut, this will release the heel from the upward pull allowing the patient to stand with foot flat on ground.
Gastrocnemius Recession is commonly performed to correct an equinus contracture of the ankle that may accompany foot and ankle pathology in adults. (An equinus deformity is basically one in which the achilles tendon is shorter than needed to allow adequate dorsiflexion during the gait cycle.
If the foot is perpendicular to the leg and put through a range of motion where the foot cannot dorsiflex (move upward) more than 10 degrees this is thought of as an equinus deformity). The equinus deformity leads to excessive pressure and pain that manifests as plantar fasciitis, metatarsalgia, posterior tibial tendon insufficiency, osteoarthritis, and foot ulcers. The procedure is also performed on individuals who have limited ankle dorsiflexion.
In the preoperative phase, many informations are obtained, a full history from the client, including allergies, medication usage, and pre-existing medical
conditions. Any previous experiences with sedation or anesthesia should to be reported, especially any adverse reactions. Note the last dose of each of the client’s prescribed medications, especially if it could alter the client’s response (diuretic, antihypertensive, narcotic). Provide education about the procedure and the medications to be used. Perform a full assessment on the client, including baseline vital signs, cardiac rhythm, and level of consciousness. Determine the last time the client ate or drank (generally NPO for 6 hrs or more before the procedure).
The client may have clear liquids up to 2 hrs before the surgery or procedure. Instruct the client to adhere to the instructions to remain NPO, or the surgery or procedure may be cancelled. Establish IV access and administer fluids as prescribed. Verify that the client signed the informed consent. Attach monitoring equipment to the client. Remove dentures (in case intubation would become necessary). Anxiety level is also assessed regarding the procedure, and coping mechanisms.
Usually many diagnostic test are performed, including Urinalysis, CBC, ECG, chest X-ray for heart and lung status and also for this case since my assignment patient was a female, a pregnancy test was performed, which came out negative.
Usually once surgery has been discussed as treatment with the client and significant other, family member, informed consent is obtained after discussing the risks and benefits of the procedure.
To obtain informed consent, the provider must give the client a complete description of the treatment/procedure. A description of the professionals who will be performing and participating in the treatment Information on the risks of anesthesia. A description of the potential harm, pain, and/or discomfort that may occur. Options for other treatments and the right to refuse treatment. The patient must give informed consent voluntarily. And the nurse is to witness the patient sign the consent papers.
The nurse remains with the client at all times. Allow other staff to assist the provider with the procedure, if indicated. Continually assess and monitor level of consciousness, cardiac rhythm, respiratory status, and vital signs.
During the procedure, the following equipment must be present within immediate reach for routine monitoring and in case deep sedation with respiratory depression occurs. Fully equipped emergency cart that includes emergency medications, airway and ventilator equipment, defibrillator, and IV supplies. A 100% oxygen source and administration supplies, airways, manual resuscitation bag, and suction equipment. ECG monitor/display, noninvasive blood pressure monitor, pulse oximeter, thermometer, and stethoscope.
The patient is placed in a supine position with leg elevated, and the surgical assistant prepares the surgical site by cleaning it appropriately. This procedure is performed with general anesthesia. When ready, an incision is made on the back inside part of the lower leg and the gastrocnemius tendon is exposed. Once the tendon is exposed, the procedure is performed by releasing it as you can see it on the monitors. This effectively lengthens the calf muscle. Patients will now have the same ankle motion with their knee straight that they previously had with their knee bent. After the calf muscle is lengthened, the wound is closed up. This was a fairly quick procedure, about 35-40 minutes.
Postoperatively, the patient is escorted to the post anesthesia care unit by the anesthesiologist and the circulating nurse who gives a verbal report to the post anesthesia care unit nurse. Initial postoperative care involves making assessments, administering medications, managing the client’s pain, preventing complications, and determining when a client is ready to be discharged from the PACU. During the immediate postoperative stage, maintaining airway patency and ventilation and monitoring circulatory status are the priorities for care. Since my assigned patient was administered general anesthesia, frequent respiratory status was required.
The nurse who is monitoring continues to record vital signs and level of consciousness until the client is fully awake and all assessment criteria return to presedation levels. Only then can the nurse remove the monitor and all emergency equipment from the bedside. Typical discharge criterias are level of consciousness as on admission, vital signs stable for 30 to 90 min, ability to cough and deep breathe, ability to tolerate oral fluids, ability to void, absence of nausea, vomiting, shortness of breath, or dizziness. And the patient is then transferred to a post surgical unit where the patient is still being monitored for any sign of complications.
The surgical leg is stabilized and put in a boot that will be in place for about 2-6 weeks. Patient teaching is done including telling the patient to keep leg elevated and keep weight off the foot. And pain level is assessed, patient is medicated as needed. Healing time for this procedure can be short or can take longer based on a some factors like nutrition, circulation, medical condition and also lifestyle, per example if you are a smoker, it will take longer. The patient was discharged to home the same day since it was an outpatient surgical procedure.
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