NUR2203 Nursing The Surgical Patient Assessment Answer
Written Assignment NUR 2203- Nursing the Surgical Patient: Task Overview
A Laparotomy surgical procedure was conducted on Ms Sarah Brown, and she returned from the operation theatre at 17:00 hrs. Sarah Brown is a 66 years old female with a medical history of Hypercholesterolemia, Hypertension, Obstructive Sleep Apnoea, Myocardial Infarction. She is a chronic smoker and has a history of Heart ailment and Cancer in the immediate family. She was admitted in the hospital with the complaint for abdominal pain and occasional diarrhoea in the last three months. The scope of this assignment includes analysing the Postoperative Surgical care for the Laparotomy Operating Procedure and issues/complications associated with it, keeping in line with the patient medical and family history.
(Adugbire & Aziato, 2020).
|Assessment||Potential problems / issues||Interventions||Rationales|
Risk of Infection
|Impaired tissue perfusion concerning tromboplebitis|
Poor skin integrity with respect to wound dehiscence or eviserasi.
Wound dehiscence is an open wound edge.
Eviserasi injury is the release of internal organs through an incision.
Factors causing dehiscence or eviserasi are wound infection, surgical error closing time, abnormal pressure on the abdominal wall as a result of coughing and vomiting.
Part B: Analysing and discussing the case to identify potential clinical issues
Post-Surgical treatment after Laparotomy surgical procedure includes the necessary care to be provided to the patients who have just undergone major abdominal surgery.
The objectives of this Post-Surgical treatment after Laparotomy surgical procedure are:
- Avoid and reduce complications after surgery.
- Fasten the healing process
- Normalizing the patient’s movements and functions as soon as possible after the surgery.
- Identifying and restoring the Patients self-identity.
- Patients discharge plan
After the surgery of Sarah was completed, she was moved to a recovery room. She stayed there for a couple of hours while she wakes up from Anaesthesia effect. Some patents feel groggy and nauseated at the time of wake up. (Cui, et al. 2018).
In the recovery room, nurse and staff monitored her blood pressure, breathing, temperature and pulse. If all the vitals are expected as in case of Sarah Brown, she has been shifted to her room, where she will be staying for one or two days depending upon the condition and then will be moved elsewhere to begin her discharge process.
Post-Surgical issues and problems includes any problems and issues as identified by the surgeon or medical practitioner after the surgery. It can occur during the operation or within 1-2 days after the operation. Sometimes, issues may arrive or exhibit themselves later on.
Complications follow abdominal surgery role a formidable challenge to the surgeon in a general surgery unit, where abdominal surgery constitutes the bulk of significant operations. They are the chief weakness of the surgeon's craftsmanship on the operation table. (Gröndahl et al. 2019).
Commencing as a seemingly minor disturbance, and if allowed to persist, they can jeopardise the patient recovery and even result in a fatal outcome. Various factors like proper resuscitation, meticulous surgical technique, and age, any co-morbid condition (coronary artery disease, diabetes mellitus, hypertension, and any chronic illness), anaesthesia technique and postoperative care contribute to the final result. These fatal outcomes are linked to the amount of care provided to the patient after the operation. Therefore, early detection and proper intervention can reduce the morbidity and mortality related to complication. (Hertel-Joergensen, Abrahamsen, & Jensen, 2018).
Hypertensive heart disease patients like our current patient Ms Sarah Brown are more prone to develop complication related to heart failure, Coronary syndrome or cardiac arrest resulting in death. Hypertension or High BP hinders the endothelial body system and increases the chances of Coronary artery disease and peripheral arterial diseases and hence leading to higher chances for associated atherosclerotic diseases. Further, Hypertension and heart diseases encompasses all the direct and indirect effects of Chronic BP which may result in Heart failure, conduction of arrhythmia particularly atrial fibrillation and higher chances of coronary artery disease.
However, hypertensive heart disease ultimately encompasses all of the direct and indirect squeals of chronic high blood pressure which include systolic or diastolic heart failure, conduction arrhythmia especially atrial fibrillation and increased risk of coronary artery disease. (Schoenfeld, et al. 2016).
Patients like Sarah who have prediagnosed condition of Obtrusive Sleep Apnoea (OSA) have much higher chances to face complications during post operation recovery period. Obtrusive Sleep Apnoea (OSA) is a very commonly known sleep and breathing disorder. Patients with prediagnosed condition of Obtrusive Sleep Apnoea (OSA) have much higher chances of complications during post operation recovery period as compared to non-Obtrusive Sleep Apnoea (OSA) patients. They type of Surgery and method of anaesthesia used could have degrading effects on patients of OSA. Loco Regional Anaesthesia is most advised anaesthetic method for patients diagnosed with OSA. (Yeung, 2016).
Since Sarah was an avid smoker, her heart and lungs are already somehow affected and does not work as well as should be. This can lead to some breathing issues during and after the surgery. Such patients are also have higher chances to develop Pneumonia. They may need to be shifted to ventilators after surgery.
In addition, Smoking also results in reduction of blood flow resulting in slow healing and which ultimately can lead to wound infection. Further, Smoking is also found to be a common cause for Heart failures and attacks and chances of the same increases in case of Sarah during the surgery.
Thus post-surgical procedures and treatment and care play a vital role in the overall health of Sarah Brown.
Part C: Discharge planning
It is utmost necessary for the Nurse to be sure that the patient is receiving case specific discharge instructions. Discharge instructions should be prescribed by the attending doctor and to be informed and explained by the nurse properly to the patient to avoid any future mistakes and complications. Doctors telephone and contact details is also included in the discharge sheets. It also includes information regarding future check-ups and visits and follow ups. This discharge instruction needs to be signed by patient, doctor and nurse. These discharge instructions shall become part of the patients chart. (Lee, Seo, Choi, & Min, 2018).
Your nurse and doctor will show you how to take care of yourself when you are discharged from hospital. Advice to be followed on the first day after surgery includes:
- Avoid driving
- Do not lift any heavy Equipments.
- Avoid to lift anything heavier than 5 lb for the coming 4 to 8 weeks giving the wound and stiches to heal properly.
- Some adult supervision/ assistance to be planned for coming 2-3 days after surgery
- Don’t drink alcohol and no smoking
- Follow your charts for all follow- up visits.
- Take proper sleep and involve yourself in quiet activities. Do not exert yourself. Exercise and other physical activities to be increased gradually over the time.
- Advise the patient in case of more specific exercises. (Kim, et al. 2019).
Tips for taking pain medicine:
- Take your medicines as prescribed.
- Take small regular meals. Try to take nutritious diet to fasten wound healing.
- Take proper sleep to accelerate healing.
- Drink lots of water and fluids and increase the fibre content in your diet. Include more and more fruits, vegetables and grains in your diet. Also take milk and other prescribed laxative to lessen the harmful effects of medications.
- Don’t overeat. Eat as required by your body.
- Take more liquids and soups initially. They get digested easily.
- Then switch to semi liquid foods including boiled potatoes, applesauce, gelatine, etc.
- Then slowly and steadily move to solid foods and diet, if your body allows it.
- Avoid spicy, oily, fatty foods at all costs for the first few weeks after surgery.
- Avoid large meals (3 times per day). Rather divide them into smaller meals.
- Always take medicines after eating solid foods to prevent nausea and vomiting and dehydration. (Shoqirat, Mahasneh, Singh, & Al Hadid, 2019)
WOUND HEALING AND EDUCATION
- Dressing needs to be changed according to the doctor’s instructions.
- Do not remove any scabs as it may result in tearing of the newly developed tissues and cells.
- Contact your doctor if there is increased pain in the wound or if wound area appears infected and shows swelling, redness and discharge is coming out from the wound area.
- Patients can take bath/ showers after 2-3 days of operation.
- Avoid tight belts and other clothes which rub against the wound.
- Wear loose clothing. (Romano, et al. 2019).
Consult your doctor- You must call your doctor if any of the conditions arises:
- Intolerable pain even after one hour of taking medicines
- In case of drowsiness, sleepiness and If you feel too groggy.
- Nauseas and vomiting issues
- Wound shows swelling, redness and discharge is coming out from the wound area
- Breathing problem and Facial swelling may require immediate call to 911.
FOR OSA patients-
- Anaesthesia is given to the patients while surgery to keep them comfortable and avoid excessive pain. Mediations may lead to the increase in times of OSA. Also the duration of OSA spells may be longer.
- The patients are advised to keep using the continuous airway pressure device (CPAP) at home during sleeping. Unless otherwise specified by your doctor, keep using CPAP device both at night and day.
- Discuss and learn before taking any pain medication, Muscle relaxants and sedatives. Your doctor shall be able to tell you all about the possible dangers of taking these medications without prescriptions and need.
OSTOMY OR STOMA (If applicable)
- Read the instructions for proper care of your stoma properly.
- If you face any issues, please call your doctor. (Tiago, et al. 2020).
Main points of the assignment are:
- Sarah Brown undergo the Laparotomy surgical procedure due to complaint about abdominal pain and occasional diarrhoea.
- Doctors conducted the colonoscopy and found a mass in the ascending colon. Initial pathology of the biopsy showed a poorly differentiated adenocarcinoma of the ascending colon.
- Sarah Brown was having a medical history of Hypercholesterolemia, Hypertension, Obstructive Sleep Apnoea and Myocardial Infarction.
- She is a chronic smoker and has a history of Heart ailment and Cancer in the immediate family.
- Postoperative care was provided to the patient by attending nurse on duty.
- Later on successful completion of Postoperative care, the patient was discharged successfully and provide with instructions and education regarding the care and medication to be taken at home followed by regular check-up and discussions with doctors and healthcare providers.