Pre-Operative and Post-Operative Skill Analysis - Case Study Example

Pre-Operative and Post-Operative Skill Analysis Name: Instructor: Course Unit: Date: Introduction: This case study report labors to respond to some pre-operative nursing care and post-operative wound management questions focused on a seventy-six (76) year old male adult, having a weight of ninety-nine kilograms (99kgs) and one hundred and fifty-three centimeters (153cm) tall. He also smokes twenty-five (25) sticks of cigarettes per day and has been admitted as well as scheduled for the repair of a right inguinal hernia. Part A: Pre-Operative Nursing Care: 1. The information obtained during the nursing admission consists of; height and weight which are important for the reason of: diet management; examination of medical condition, this is, it designates whether the patient is obese, underweight, or has edema (has fluids retained in the body), hence allowing the medical practitioners to monitor alterations in weight attributable to particular disease developments and establish the efficiency of nutrition supplements recommended to sustain weight; and for the calculations of drug dosages which is regularly prescribed with respect to a patient's weight when a definite blood concentration of the drug is preferred, likewise larger dosages could be necessitated in a heavier individual (Ducatman et al. 2009, pp. 37-40). Age is one of the important information obtained. The reason for recording the patient’s age is that, as an individual age advances metabolism is often slowed, causing drugs to remain in the body longer than usual, thus it’s important to note the years so that proper medication is administered. The sex is also important as male and female respond differently to some medication. The name is recorded as it serves as a basis for filing and documentation, hence enhancing communication between the medical practitioner as well as any other health expatriate assisting. It also aids in safe guarding the legal concern of the patient. The numbers of cigarettes taken per day are important in order to try and asses the damage caused (Ibid). 2. Baseline data refers to the critical information prior to the patient admission, which includes; age, gender, weight and height. It is very important in that it’s used afterward to offer a contrast for evaluating the diagnosis impact. The vital sign is one of the important information obtained and takes account of the: body temperature, pulse which is taken to establish whether the heart beat is normal, weak or irregular, respiration which is taken to ascertain if the breathing pattern is rapid, normal, slow, difficulty (Dyspera), orthoprea (breathes only in upright position), or has cheyne stokes- whereby the breathing pattern is portrayed by deep breaths of thirty seconds tagged along by lack of respiration for ten to thirty seconds; and blood pressure which is taken to establish whether the patient has normal, high or low blood pressure. Concisely these readings are termed vital signs since they all must be in attendance for life to carry on, in other words they are pointers of body functions (Ducatman et al. 2009, pp. 37-40). Other important information includes: social and chemical use histories, which are important for the reason that the patient's present vital signs can be weighed against with those acquired in the past or with standard assessments and adjustments in health due to social behaviors and/or chemical uses can be identified and taken care of promptly. Social history precisely refers to the account of the patient interactions. It gives the correlations of the patient, his/her careers as well as trainings, education and lifestyle. It’s significant in that it puts in plain words the actions of the patient with respect to the illness. It could also provide clues as to the cause of an illness, for instance the cigarette smoking and the number of sticks smoked per day. Lastly a comprehensive nursing assessment that comprises of: an examination of systems, neurological condition, therapeutic and psychiatric history, and a medication history, need all to be noted so as to establish any ill-health conditions and complications that might not be visible at the time of examination. The entire baseline data mentioned above do provide a basis for the development of a treatment plan during the end of the nursing admission and pre-operative period. During the post-operative period the baseline data is compared by the pre-operative baseline data to examine how the patient is responding to the diagnosis, and in measuring improvement in health status and functionality. Having the baseline against which to measure improvement is also important in motivating the patient during the post-operative period and motivating the nursing staff and in accounting for the value of the nursing care progress (Lubin et al. 2003, pp. 40-56). 3. The ethico-legal requirements of the nurse comprise of; the responsibility for overseeing the schedule and completion of nursing admission the patient has a problem list and plan of treatment, and that any pre-operation procedures and other limitations are dully communicated to the surgeon. The ethics of autonomy to the patient should also be observed by the nurse, which provides the patient with a right to refuse the surgery regardless of explanation of the nurse. The nurse has also the ethico-legal requirement of telling the patient truthfulness and faithfulness (Feutz-Harter, 2006, pp. 20-60). The nurse also is obliged to carefully collect vital signs and diagnostic information, making observations of the patient condition and behavior, and using objective terminology to describe the patient’s condition in the health record during the pre-operation period. This greatly facilitates the accuracy and timeliness of baseline screening. Confidentiality of the patient’s baseline data and other vital information is another aspect of the ethico-legal requirements that the nurse should observe fro the time of the nursing admission. Above all, the nurse is supposed to physically and psychologically prepare and manage the patient before the surgery (Ibid). The patient’s written consent for the surgery is a fundamental part of the pre-operation care. Through the ethico-legal requirement the surgeon to carry out the surgery must enlighten the risks as well as the advantages of the surgery, along with other treatment alternatives. Never-the-less the nurse is the one who in point of fact will witnesses the patient signature on the consent form. The nurse also should make certain that the patient comprehends everything and at times should request the patient to repeat what he has been told so as to analyse how much he has understood. The main goal of this is to reduce complications thus promote recovery (Lubin et al. 2003, pp. 40-56). Part B: Post-Operative Wound Management: 1. Assessment is the initial step in the development of personalized nursing care. It grants information that is important to the development of a course of action that boosts the patient wound care status. It furthermore minimizes the possibility of, or the severity of, unceasing wound conditions and helps the patient to be in charge of the wound through self care (Grey et al. pp. 285-288). 2. The interventions undertaken when assessing the wound comprise of: first taking of vital signs of the patient and assessing of the surroundings, in order to achieve a comprehensive care plan; identification of the wound aetiology, for instance establishment of the characteristics of the tissue, which provides a focus for infection, and establishing if the thick yellow discharge oozing is restricted to the top of the wound or deep inside; and if at all there is breakdown of the wound. Treatment of the infection comes last and should be first and foremost a clinical proficiency and microbiological data should be applied to supplement the treatment. Characteristic signs to be noted should include pain, greater than before heat and if the discharge is in plenty (Grey et al. pp. 285-288). 3. Aseptic technique is a set of particular practices as well as procedures applied under cautiously managed circumstances with the objective of minimizing infection and contamination of the wound by pathogens, which in this case has failed due to the presence of the thick yellow discharge oozing from the wound an indication that the wound has been infected by pathogens Wilson, 2006, pp. 49-53). 4. The interventions undertaken in relation to aseptic technique include; making certain that only sterile apparatus and fluids are utilized during the dressing process so as to nurse back to health the wound and to inhibit contamination of the patient’s surroundings; following the at all times the manufacturer’s recommendation for all the clinical supplies in order to avoid any ethical consequences that could be detrimental to both the nurse and the patient; Use of sterilized gloves or forceps to avert additional infectivity; use of the six-step sanitization technique that makes certain that all exteriors of the hand are swathed; avoiding dressing the wound and/or taking an aseptic process for a minimum of thirty minutes after bed making or cleaning the ward, so as not to allow any particulate matters settling on the wound therefore contaminating it (Pratt et al. 2007, pp. 1-64). 5. Two causative factors of wound breakdown in relation to the case study include; infection of the wound by pathogens and extreme tissue tension on the opening when closed. Infection of the wound could be through contamination of the wound for instance during dressing. This infection could eventually destroy the sutures and tissues thus leading to the wound breakdown. Additionally the white blood cells are sidetracked from the healing process of the wound to fight the pathogens that have infected the wound (Midwood et al. 2004, pp. 1031-1037). Extreme tissue tension when the opening is closed could be another factor leading to the wound breakdown. This may lead to the sutures to rip from end to end of the tissue when extra tension is put on it, for instance when lifting a heavy body or coughing. The extreme tissue tension can minimize blood flow to the tissue surrounding the wound itself; this consequently causes the tissue breakdown as well as the suture to draw through (Ibid). 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