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NURS115 Nursing the surgical patient

University: Wembley High Technology College

  • Unit No: 13
  • Level: High school
  • Pages: 12 / Words 2951
  • Paper Type: Dissertation
  • Course Code: NURS115
  • Downloads: 38
Question :

This assessment will cover the following questions:

  • Consider the appropriate post- operative education for the surgical procedures.
  • Define the issues of the patient care and involves potential nursing care for Wendy and determination of potential clinical issues associated with Wendy case.
Answer :

INTRODUCTION

Surgical nurses are also best known as the perioperative nurses who works in Operative Room and they are present during and after the surgery is done. There are many specific things that a perioperative trained registered nurses effectively practices to aid the patient care and to help the surgeons during the surgery. Diarrhoea is loose or reeking stool and possibly more-frequent viscus or bowel movements is an ordinary health associated difficulties. It is mainly accompanied with other abdominal pain, weight loss etc. Abdominal pain is pain which is felt betwixt the chest and groin (Anania and et. al., 2021). The report entails the case scenario of Wendy Green who has undergone a laparotomy and the care that is mainly concentrated on the first 24-hours of post-surgical care. The report also entails the defining the issues of the patient care and involves potential nursing care for Wendy and determination of potential clinical issues associated with Wendy case.

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PART A- Analyse the case to identify potential clinical issues and relevant nursing care (1100 words)

Identify Three Priority clinical issues for Wendy

Mrs. Wendy Green is a 64-year old teacher who is being presented to General Practice who also had a three month history of abdominal pain and diarrhoea. There was a colonoscopy and CT scan done to learn about the tumour in the ascending colon of Mrs. Wendy. For this, Wendy was imposed for an open right hemicolectomy (Chaouch and et. al., 2020). A colectomy process is an essential procedure to remove the one side of the colon and this process is known as hemicolectomy. An open right hemicolectomy encompasses attaching the small intestine to the unexpended part of the colon. Here the nurses are efficiently able to provide the patient care with effective control of prompt pain, other assessment of the surgical site that is painful and requires healing. Other nursing intervention that are required in post-operative care to the surgical patient are drainage tubes, monitoring the magnitude and openness or patency of intravenous fluids and intravenous access. Mrs. Wendy can be efficiently taken care of the pain that is associated with the surgery and the level of pain and sensation should be minimised to aid the healing process. Laparotomy is also known as celiotomy which is performed by making a big incision in the abdomen to gain the peritoneal pit within the surgical patient such as Mrs. Wendy (Daniels and et. al., 2021).

There are several clinical issues with Mrs. Wendy and some of them entails the under mentioned:

  • Anastomotic leak: Leak rates from laparoscopic right hemicolectomy are majorly around 4% and this represent the major jeopardy to morbidity in case of Mrs. Wendy undergoing the surgical operation. Risk factors for a leak can be majorly categorised into local and generalised effectively. General causes entails poor nutritional state, anemia and other associated sepsis.
  • Bleeding: Other clinical issues associated with Mrs. Wendy involves the bleeding which will effectively cause blood loss in Mrs. Wendy (Hasak and et. al., 2018).Worried for assignment help? Talk to our experts now!
  • Conversion to open: The third clinical issues with Mrs. Wendy involves indications for open surgery entailing extensive adhesions and T4 tumours can be effectively with surrounding invasion, haemorrhage. Conversion to open is associated with worse entire endurance in curable resections.
  • Other clinical issues with the patient Mrs. Wendy with complaints of abdominal pain and diarrhoea may result from stress or any other associated chronic conditions, for instance as irritable bowel syndrome (IBS).

Identify Nursing Intervention for each of the three clinical issues.

Nursing interventions are active actions and plan of strategies a nurse takes to implement their patient care plan, entailing any associated treatments, processes or teaching moments intentional to evolve the patient's consolation and well-being (Jurowich and et. al., 2019).

  • The nursing intervention in the case of Mrs. Wendy with the clinical issue Anastomotic leak involves the leaks which are found can eventually be repaired. Therefore, early diagnosis and intervention are vital for managing infections of the surgery and controlling the sepsis. In general, who is Mrs. Wendy suffering anastomotic leaks are more vital at risk of further health complications and mortality down the road. Antibiotics should be prescribed and medication adherence must be followed by the drainage system for the patient by the surgical nurses to aid the difficulties associated and accompanied with the surgery (Jurowich and et. al., 2019).

Vacuum therapy can be an effective measure for intervention in Mrs. Wendy. Surgical intervention and minimally invasive techniques to cure and intervene the difficulties with the patient must be entailed with patient care.

  • Nurses can effectively save all the perineal pads which can be utilized during bleeding and weigh them to examine the quantity of blood loss. Mrs. Wendy can be placed side lying position to make sure that no blood is pooling underneath the patient. Assessing liquid body substance frequently to examine the amount of blood discharged is still within the normal limits of the patient or not.
  • Conversion to open nursing interventions includes undertaking Mrs. Wendy to optimal respiratory function, and other preventing complication associated with the patient (Lin and et. al., 2021). Management of pain and provision of vital information about the disease with effective treatment needs must be fulfilled.
  • The patient surgical registered nurse can impose Mrs. Wendy to take a well-balanced diet to improve health and eat high-fibre diet, also avoid any gas forming foods to intervene the process of health associated risks. Avoiding fluid intake with meals can be an essential preventive measure as this causes abdominal distension. Adhering to a plan of nightly work efficiently (Matsuda and et. al., 2020). Nurses can majorly impose Mrs. Wendy in regular exercise and which declines the anxiety and inclines intestinal motility. Deep breathing exercise should  also be imposed in Mrs. Wendy to recover fast from the ailments that is encompassed with the patient.

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Provide rationales for each nursing intervention.

Abdominal pain is accompanied with diarrhoea in Mrs. Wendy. Here some of the major and common causes involves food sensitivities, other bacterial or viral contagion which can be distressing for Mrs. Wendy. This may also outcome from various stress an other associated chronic conditions. Usage of alcohol use and other medications must be administrated and monitored in the case of Mrs. Wendy (Maynard and et. al., 2021).

According to surmises that one primary reason for executing the preoperative medical practices and evaluation is mainly to make surgeries more sound and safer. This will eventually decline the modifiable risks associated with Mrs. Wendy. Rationales entailing test which are capable of determining the modifiable health risk or nay such therapeutic intervention measures is capable of declining modifiable risk, those health care services may be appropriate.

  • Intervention: Eating healthy and balanced-diet to intervene the situation of abdominal pain and diarrhoea. Rationale: The rationale in the case of Mrs. Wendy for an intervention could be to lead a healthy life.  The medical and nursing interventions can be imposed as the patient may suffer from irritable bowel syndrome and other allergic responses due to surgery of open right hemicolectomy.
  • Intervention: Saving all the perineal pads used during the surgery. Rationale: Post-surgery, it is very common to have minor bleeding from the cut that was made in patient Mrs. Wendy by the doctor. But the difficulties may occur to the patient to bleed too much accompanied with pain. An injury or cut to a blood vessel can majorly cause bleeding post surgery. Other causes entails medications such as aspirin or other appropriate anticoagulants which will majorly cause blood thinning (Morales-Soto and et. al., 2019).
  • Intervention: Conversing to open nursing interventions such as optimal respiratory function. Rationale: This very intervention entails the incisions which is effectively made earlier than planned. Adhesions from antecedent surgeries or from any past or recent incendiary, inflammatory outcome is the main reason behind the rationale mentioned here. With these rationales Mrs. Wendy can be given a healthy intervention by the health care nurses and nurses are efficient in providing appropriate surgical patient care knowledge and nursing practices.

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PART B- Discharge planning (700 words)

Plan and prioritise discharge advice for Wendy.

Discharge process entail the discharge of a patient from the medical premises post-treatment. The hospital discharges the patient when the patient no longer requires inpatient care and are imposed to go back to their homes. Discharging planning for Mrs. Wendy encompasses an interdisciplinary approach and methods to continuity of patient care and an effective process which efficiently comprises determination, identification, proper evaluation, applicable goal setting and other associated planning to the patient care. Other processes entails the coordination and assessment of the patient with effective approaches to aid the patient with the recovery processes. Nurses must effectively abide by the patient care measures and do not refuse to render treatment to the patient. In case of Mrs (Panayi and et. al., 2019). Wendy, the surgical patient registered nurse must provide whatever treatment  is required post surgery and discharge. They should follow-up the prescriptions, their appointments, and the particular discharge instructions for the patient's well-being the patient will receive from the health care nurses. A written transition plan or discharge summary entirely involves the diagnosis, an active difficulties with the patient, their medications and other required services with the patient to aid their ailments effectively. The written transition plan or discharge plan also includes the warning signs, emergency contact and their vital informations which is to be looked effectively to aid the impairment.

Nursing planning should entail the patient, their family members and associated health  care providers to aid the distresses. The discharge plan should include an interdisciplinary approach to continuity of patient care and this is a process which encompasses the determination, evaluation effectively. The nursing discharge plan should include the instructions on how to take care of their wounds and dressings to aid the ailment in the case of Mrs. Wendy. This also includes the informations about the medicines (Scheirey and et. al., 2018).

In the discharge plan, consider the appropriate post-operative education for Wendy including the surgical procedure.  Concisely provide a discharge plan and education around medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification.

Post-operative education should be provided effectively by the surgical nurses to Mrs. Wendy while planning the discharge course. The discharge planning entails the suggestions to prevent any sort of infections and substances that may cause unhealthy health complication post chemotherapy. Mrs. Wendy must be imposed to healthy diet plans to adopt quality lifestyles living and drinking purified water (Wetzel and et. al., 2018). The nurses must impose healthy education about medication adherences and benefits of following up the prescribed drugs to aid the cut post surgery. The general responsibility and duty of nurses comprises boosting up Mrs. Wendy to revise their prescription routine so that they take them effectively and do not misses them. Post-operative complications involves the weaknesses, immunity, vulnerability towards other ailments and infections, sore mouth, bleeding issuances and bruising with loads of hair loss also (Thapar and et. al., 2020). The other complications includes the tiredness, feeling and being sick of the disease and loss of appetite. Mouth care, body hygiene and practising exercise to daily routine can be effective in measuring the therapy of post surgery interventions and other complications such as preventing the hair loss difficulties. Chemo therapy triggers the feelings of stress, anxiety and feeling of frustration too.

Refrain from merely providing generic information.  Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan.

With the provided case of Mrs. Wendy, the women is a professional teacher. The women is a 64-year old and the lady was presented to the General Practitioner as the woemn is ahaving a medical history of abdominal pain and diarrhoea (Waters and et. al., 2020). And then the women was imposed to a colonoscopy and CT scan which effectively revealed of tumour in the ascending colon of Mrs. Wendy. After this the women was scheduled for an open right- hemicolectomy surgery. Here, the nurses plays an important role by giving the patient post-surgical patient care.

CONCLUSION

From the above discussion, it is being conferred that the Mrs. Wendy is a 64-year old professional teacher who is being presented to the general practitioner and had a history of abdominal pain and diarrhoea too. Wendy is then imposed to effective surgical operations followed by effective chemotherapy and surgeries it aid the open right hemicolectomy. Wendy is taken care of by the surgical patient registered nurses to aid the ailments and different clinical issues with their interventions were primarily take care of. Discharging process with effective dietary plans have been also discussed wit the patient to prevent the infections and health the bruises chiefly. Worried for essay help? Take experts help now!.

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REFERENCES

Anania, G., Arezzo, A., Davies, R.J., Marchetti, F., Zhang, S., Di Saverio, S., Cirocchi, R. and Donini, A., 2021. A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision. International journal of colorectal disease, 36(8), pp.1609-1620.

Chaouch, M.A., Dougaz, M.W., Mesbehi, M., Jerraya, H., Nouira, R., Khan, J.S. and Dziri, C., 2020. A meta-analysis comparing hand-assisted laparoscopic right hemicolectomy and open right hemicolectomy for right-sided colon cancer. World Journal of Surgical Oncology, 18(1), pp.1-9.

Daniels, I., Tuson, R. and Hargreaves, J., 2021. What are the financial implications of an open right hemicolectomy to hospital trusts within NHS England? A cost analysis. BMJ open, 11(12), p.e053187.

Hasak, J.M., Bettlach, C.L.R., Santosa, K.B., Larson, E.L., Stroud, J. and Mackinnon, S.E., 2018. Empowering post-surgical patients to improve opioid disposal: a before and after quality improvement study. Journal of the American College of Surgeons, 226(3), pp.235-240.

Jurowich, C., Lichthardt, S., Kastner, C., Haubitz, I., Prock, A., Filser, J., Germer, C.T. and Wiegering, A., 2019. Laparoscopic versus open right hemicolectomy in colon carcinoma: A propensity score analysis of the DGAV StuDoQ| ColonCancer registry. PLoS One, 14(6), p.e0218829.

Jurowich, C., Lichthardt, S., Matthes, N., Kastner, C., Haubitz, I., Prock, A., Filser, J., Germer, C.T. and Wiegering, A., 2019. Effects of anastomotic technique on early postoperative outcome in open right-sided hemicolectomy. BJS open, 3(2), pp.203-209.

Lin, T.Y., Chuang, Y.C., Kao, F.C., Ping-Yeh, C., Tsai, T.T., Fu, T.S. and Lai, P.L., 2021. Early detection and intervention for acute perforated peptic ulcer after elective spine surgeries: a review of 13 cases from 24,026 patients. BMC Musculoskeletal Disorders, 22(1), pp.1-8.

Matsuda, T., Endo, H., Inomata, M., Hasegawa, H., Kumamaru, H., Miyata, H., Sakai, Y., Kakeji, Y., Kitagawa, Y. and Watanabe, M., 2020. Clinical outcome of laparoscopic vs open right hemicolectomy for colon cancer: A propensity score matching analysis of the Japanese National Clinical Database. Annals of gastroenterological surgery, 4(6), pp.693-700.

Maynard, M.T., Mathieu, J.E., Rapp, T.L., Gilson, L.L. and Kleiner, C., 2021. Team leader coaching intervention: An investigation of the impact on team processes and performance within a surgical context. Journal of applied psychology, 106(7), p.1080.

Morales-Soto, W. and Gulbransen, B.D., 2019. Enteric glia: a new player in abdominal pain. Cellular and molecular gastroenterology and hepatology, 7(2), pp.433-445.

Panayi, A.C., Orkaby, A.R., Sakthivel, D., Endo, Y., Varon, D., Roh, D., Orgill, D.P., Neppl, R.L., Javedan, H., Bhasin, S. and Sinha, I., 2019. Impact of frailty on outcomes in surgical patients: a systematic review and meta-analysis. The American Journal of Surgery, 218(2), pp.393-400.

Scheirey, C.D., Fowler, K.J., Therrien, J.A., Kim, D.H., Al-Refaie, W.B., Camacho, M.A., Cash, B.D., Chang, K.J., Garcia, E.M., Kambadakone, A.R. and Lambert, D.L., 2018. ACR Appropriateness Criteria® acute nonlocalized abdominal pain. Journal of the American College of Radiology, 15(11), pp.S217-S231.

Thapar, N., Benninga, M.A., Crowell, M.D., Di Lorenzo, C., Mack, I., Nurko, S., Saps, M., Shulman, R.J., Szajewska, H., van Tilburg, M.A. and Enck, P., 2020. Paediatric functional abdominal pain disorders. Nature reviews Disease primers, 6(1), pp.1-23.

Waters, P.S., Cheung, F.P., Peacock, O., Heriot, A.G., Warrier, S.K., O'Riordain, D.S., Pillinger, S., Lynch, A.C. and Stevenson, A.R.L., 2020. Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer–a systematic review. Colorectal Disease, 22(5), pp.488-499.

Wetzel, M., Hockenberry, J. and Raval, M.V., 2018. Interventions for postsurgical opioid prescribing: a systematic review. JAMA surgery, 153(10), pp.948-954.

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