The Psychosocial Impact of Surgical Intervention - Case Study Example

Question and answers to Amy’s case study Name Institution Date Question 1. Identify the psychosocial impact of surgical intervention including the psychosocial impact of elective and emergency admissions, separation, and loss of income and/or loss of control as related to the case study Psychosocial issues entail the dynamic link involving the social and psychological effects that affect an individual in case of an event (Preedy & Watson, 2010). With regards to psychology, the involved domains include and not limited to emotions, thoughts, behaviors, mind, and feelings. The social impact concerns one’s environment, traditions, family relationships, culture, friends, community, and daily tasks like work or school. Amy’s concern is that she will miss out having fun at school, miss her teacher and playing with her friends in the playground. It may be a very frightening situation for children who are young to be within a place that is unfamiliar and be separated for some time from their friends and parents (Kutscher & American Institute of Life-Threatening Illness and Loss, 2004). Emergency admission which may also entail hospitalization is particularly upsetting since children might be separated with their loved ones particularly parents especially when the feeling of being threatened in the course of surgery or treatment is at optimal. Parents are considered a child’s entire world as well friends that are most trusted (Shield, et al, 2012). In those circumstances when a child, for instance with regards to the case study, Amy, is separated, she will be required to utilize all her emotional energy in order to avoid feeling victimized and entirely helpless; this energy is to be used in order to cope. According to Preedy & Watson (2010) a lot of children might appear like they cope very well, however, it might be at some cost. The price may be very high in terms of lifelong consequences from the terrified experience, feeling helpless, and left by their parents or friends. Loss of income may be another psychosocial impact caused by emergency admission. This is because a parent may be required to be with his or her child during the hospitalization period, hence likely to loss his or her job. This event can be very depressing to parents since they are left in the dilemma of choosing either to be with their child at the hospital or maintain their job as seen in the case study where Amy’s both parents work. Nurses can play a great role by providing sufficient education to the child and the family (Shield, et al, 2012). Question 2. Explain the recovery process of your chosen patient. Identify and provide rational for airway management as related to the case study. Recovering from a surgical procedure is to a great extent reliant upon the kind of surgery that one is having (Isaacson, 2012). With respect to the case study, Amy had a tonsillectomy + adenoidectomy. The period of tonsillectomy recovery is very painful. There exists normally two phases to recovery. The initial period is severe while the second is less severe, prior to going back to ordinary health. In children, the initial phase takes five to seven days, and this is the time when the throat’s covering is re-growing. The subsequent phase takes another five to seven days among children; however, the child experiences some pain when coughing, sneezing, and yawning. Dehydration is regarded the leading enemy during the period of recovery. It increases pain, the infection or bleeding risk, and delay healing process. This normally takes place since the pain caused by swallowing prevents the patient to drink adequate liquids. Hence, it is important to force liquids, and this can be achieved when there is maximization of pain control. Management of airway is the leading priority for health care. The rationale is that in absence of airway, breathing will be absent as well, thus lack of blood oxygenation and hence circulation may cease soon (McInerny, et al, 2009). According to the case study, Amy is placed in the left lateral position to facilitate with secretions’ drainage which may distract effective airway. Question 3. Identify the assessment and nursing intervention involved in addressing the patient’s pain as related to the case study? Signs that children are in pain include and not limited to: poor feeding, crying, lethargy, sleeplessness and sad facial expressions (Betz & Sowden, 2008). It is imperative to note that other factors may also influence children. For instance, a child might have an intense fear towards the procedure of surgery, which may last post surgery; hence the child would believe that surgical pain is therefore a punishment. Therefore, sufficient explanation to the child about what is happening and why is very vital. According to Wiggins & Foster (2007) control of pain in the course of post operative phase is very important, since movement may bring about a raise in the level of pain. Being without pain is not an expectation that is practical, however, pain ought to be controlled adequately to facilitate coughing and movement. With respect to the case study, assessment entails sore throat, laboured breathing and uncontrolled rigors. The nursing diagnosis is pain in relation to post surgical procedure as demonstrated by facial grimace. The plan is that after thirty minutes of interventions, the child should present a reduction in pain. The nursing intervention involves positioning Amy to a comfortable state. The rationale is to offer comfort. Amy has been written up for normal 4-6hrly oral paracetamol 855mgs. Additional PRN relief of pain has also been order for Amy, consisting of 28.5mgs oral codeine and 57mgs IV tramadol. Question 4. Develop a (case report) nursing care plan focusing on the post operative care in the first 24 hours. In order of priority, using evidence based literature, identify and discuss nursing are and rationales as related to the case study. Nursing assessment regarding tonsillectomy + adenoidectomy includes assessing hardship in swallowing, and choking easily (Potts & Mandleco, 2007). It is also important to assess presence of sore throat, both chronic and acute. Assess sore throats’ history. Assess any presence of bleeding via the mouth. Assessing whether the child has asthma or cystic fibrosis is also important. Some of the nursing diagnoses include and not limited to: fear secondary to hospitalization in addition to unfamiliar individuals as evidenced through unsettledness, acute pain in relation to procedure that is invasive as evidenced by sore throat, impaired swallowing secondary to pain evidenced by crying, infection risk in relation to invasive surgery, risk for nutrition that is imbalanced: less than what the body requires secondary to invasive surgery as proved by limited oral intake as well as throat pain, and risk for temperature that is imbalanced secondary to invasive surgery and hospitalization. The following are some of the nursing diagnoses, associated interventions and rationale in order of priority. Pain secondary to surgical procedures; the objective is that the child will state controlled pain or lost pain, the child appears relaxed, rests or sleeps. Vital signs need to be monitored every four hours as well. The rationale is that vital signs are able to establish cardiovascular reaction to illness together with treatments’ effectiveness (Potts & Mandleco, 2007). Tonsillectomy is a procedure that is quite uncomfortable as well as painful. The throat of a child is exceptionally sore after the surgical procedure. Analgesic medications like oral paracetamal 855mgs. PRN pain relief which has oral codeine 28.5mgs and IV tramadol 57mgs are to be administered as prescribed by the doctor. The child should be given soft foods due to difficulty in swallowing caused by pain. To avoid nausea which is a common experience following an invasive surgical procedure (Baker, 2006), Amy is to be given ondansteron 4mgs. With respect to risk for deficit in fluid volume in relation to loss of blood from surgery, the outcome is that the blood pressure together with the pulse of the child will remain within the normal parameters for age; and no presence of extensive bleeding (Axton, et al, 2009). Sodium chloride 0.9 percent infusion will help Amy for hydration at 90mls/hr, which remains insitu until she is able to tolerate oral fluids. With regards to infection risk in relation to invasive surgical procedure, the desired outcome is that there will be no infection and complication due to surgery (Taylor et al, 2011). Interventions include monitoring temperature in every four hours. The rationale is that changes in body temperature could indicate presence of infection or ineffective circulation (Axton, et al, 2009). According to the case study, Amy’s uncontrolled rigors could be managed by provision of a warmer setting. Administration of antibiotics also plays a key role in preventing infections. Amy has been given an IV dose of antibiotic intraoperatively but she is to continue the remaining five day course on 570mgs cephalexin oral antibiotics. Dexamethasone 5.7mg is to be administered as a corticosteroid. Educating the family prior to discharge is very important (Axton, et al, 2009). Amy’s mother needs to be educated about care of her daughter while at home so as to avoid any infection or injury. Some of the principal factors include provision of adequate fluids to maintain hydration, restrictions to strenuous activities to enhance healing process and adherence to medication for effective healing. Reference list Wiggins, S. A., & Foster, R. L. (2007). Pain after tonsillectomy and adenoidectomy: "ouch it did hurt bad". Pain Management Nursing : Official Journal of the American Society of Pain Management Nurses, 8, 4, 156-65. Baker, K. (2006). An overview of current techniques for tonsillectomy. Orl-head and Neck Nursing : Official Journal of the Society of Otorhinolaryngology and Head-Neck Nurses, 24, 3, 8-12. Betz, C. L., & Sowden, L. A. (2008). Mosby's pediatric nursing reference. St. Louis, Mo: Mosby/Elsevier. Shields, L., Zhou, H., Pratt, J., Taylor, M., Hunter, J., & Pascoe, E. (2012). Family-centred care for hospitalised children aged 0-12 years. Cochrane Database of Systematic Reviews (online), 10. Taylor, C. et al. (2011). Fundamentals of nursing: The art and science of nursing care. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Preedy, V. R., & Watson, R. R. (2010). Handbook of disease burdens and quality of life measures. New York: Springer. Kutscher, A. H., & American Institute of Life-Threatening Illness and Loss. (2004). Living under the sword: Psychosocial aspects of recurrent and progressive life-threatening illness. Lanham, Md: Scarecrow Press. McInerny, T. K., Adam, H. M., Hoekelman, R. A., & American Academy of Pediatrics. (2009). Textbook of pediatric care. Washington, D.C: American Academy of Pediatrics. Axton, S. E., Fugate, T., & Axton, S. E. (2009). Pediatric nursing care plans for the hospitalized child. Upper Saddle River, N.J: Pearson Prentice Hall. Potts, N. L., & Mandleco, B. L. (2007). Pediatric nursing: Caring for children and their families. Clifton Park, NY: Thomson Delmar Learning. Isaacson, G. (2012). Tonsillectomy healing. Annals of Otology, Rhinology and Laryngology, 121, 10, 645-649. Read More