Nursing Care of Postoperative Patients - Essay Example

?Reflection Section My practice area is the surgical ward area, specifically, in the Ear, Nose, and Throat specialization. This practice area primarily admits patients who are about to or who have undergone surgery. Most of the patients in this ward are ENT surgical patients, about to be scheduled for surgery or undergoing pre-operative procedures, including medical tests prior to surgery. Tasks for these preoperative patients include checking of test results, clearing of surgical needs including antibiotic therapy, and checking for availability of blood for possible transfusion during surgery. Easing patient anxiety is also part of our functions as nurses in the surgical ward. Postoperative anxiety is to be expected for these patients, and nurses and other health practitioners within the surgical ward are tasked with educating the patient about the surgery, providing emotional support, and reducing the emotional impact of the surgical procedure. Some of the other patients in the surgical ward are also undergoing postoperative care. Postoperative care for these patients include pain management, monitoring of vital signs, monitoring for bleeding, and monitoring for infection. In the case of the patient subject of this reflection, the patient is a 55 year old female patient who has recently undergone thyroidectomy. She is married, with 3 children, and has worked as a school teacher for 35 years. Six months ago she first noticed that there was a lump at her throat area. She ignored it at first, but four months prior to the surgery, the lump seemed to get bigger. Upon seeking medical consult, she was diagnosed with hyperthyroidism. This caused her goitre. After a month of treatment, her goitre continued to enlarge. Hence the thyroidectomy was scheduled. Post-operative pain medications were ordered for the patient by his attending surgeon. In this case, the controlled drug morphine was ordered. The patient registered pain levels on the scale of 1-10 (with 10 being the most severe) at 9/10. The pain was localized at the incision site at her throat area and she described it as a throbbing and persistent pain. She also registered pain when she would move. The administration of the morphine managed to reduce the pain levels to 3/10. Additional pain management included guided imagery where the patient was asked to picture pleasant scenarios as a means of distracting herself from the pain that she was feeling. I also checked the incision site for signs of bleeding and infection. I also monitored her blood pressure and vital signs. Her blood pressure as well as vital signs remained within normal levels within the postoperative period. The administration of the morphine Oramorph SR was orally through a tablet every 12 hours. Based on hospital policy, no more than 2 tablets were administered to the patient within a 24 hour period. Morphine was also not administered when necessary as per hospital policy. An order by the attending physician was necessary before morphine could be administered. The nurses are required to instruct patients not to chew the tablets before swallowing because it can cause the release of the drug into the body all at once, possibly causing serious health issues, in some cases, death. The patient’s mouth was also washed after each administration. I was also asked to check for side or adverse effects of the drug, including: dizziness, lightheadedness, nausea, vomiting, diarrhoea, weight loss, dry mouth, headache, confusion, stiff muscles, mood changes, chills, and flu symptoms. More serious symptoms requiring immediate medical care included slow or irregular breathing, bluish coloration to the skin, fast or slow heartbeat, seizures, hallucinations, blurred vision, hives, and rashes. Section 2 While caring for this patient, I was able to learn more about the protocols in the administration of the controlled drug morphine. The learning was able to emphasize the importance of understanding the application and use of controlled drugs, especially those used for pain relief (Hardwick, 2009). The care administered to this patient provided an improved understanding of morphine (Hardwick, 2009). In the health care practice, reflection is an important resource in learning and improving one’s nursing skills and health practice (Taylor, 2000). Critical reflection also helps support the establishment of efficient registered nurses (Taylor, 2000). Medication administration is one of the primary roles of nurses and it is incumbent upon the nurse to ensure that there are no errors in the administration of drugs and that the different ‘rights’ (right drug, right dose, right patient, right frequency, right time) are complied with by the nurse (Goldsworthy, 2007). This paper seeks to assess the patient administration of the controlled drug morphine to the postoperative patient. This reflection shall apply the Taylor model, specifically, the emancipator reflection model in order to evaluate the incident and establish a clear review of the actions undertaken during the incident (Taylor, 2000). I. Constructing The significant issue in this situation involved the processes related to the administration of the controlled drug morphine. In this encounter, I tried my utmost to comply with the hospital protocol in morphine administration and to also ensure that the patient was correctly administered the drug. I reviewed the incident and all the pertinent details needed in patient care and medication administration and was able to understand how patient details are needed in order to safely administer the medication. II. Deconstructing I felt some anxiety during the incident because the drug I was administering was a controlled medication (Keohane, 2008). I felt anxious about making any errors in medication and of possibly encountering some adverse effects from the patient from her intake of the powerful pain medication (Keohane, 2008). I also felt that it was incumbent upon me to be vigilant with the patient in order to ensure that no problems would arise from his drug intake. I also felt concerned about the patient and the pain she was encountering (Keohane, 2008). I felt that it was up to me to help physically and emotionally ease her pain. In reflecting on the incident, I can say that my response and my actions during the incident were effective. First and foremost, upon receiving the patient from the recovery room nurse, I immediately checked her vital signs, her wound site, and her pain levels (Hurley, 2006). These were essential postoperative details that were necessary in the management of the patient (NICE, 2008). I then went on to check for any due medications, and saw that her morphine was due in 12 hours. The patient was responsive and conscious and as I spoke calmly to her, she was also able to relax under my care (Leinonen, et.al., 2008). I also provided emotional support by listening to her express how she was feeling after the surgery and how anxious she felt about the surgery’s outcome. I reassured her that the surgery went well and that she did very well as well. She also felt more relaxed once I told her that her family would be in to see her in a few hours time. I then allowed her to rest from her surgery. The gestures that I manifested are essential gestures which help relax patients (Coakley and Duffy, 2010). These gestures provide emotional support for the patients, especially in the wake of any momentous medical procedure (Royal College of Nursing, 2011) Postoperative monitoring is also an important element of patient care because these patients have the highest risk of experiencing various issues including bleeding and infection (Coakley and Duffy, 2010). Monitoring the patient after the administration of the morphine was also an essential part of the patient care because as was previously mentioned, morphine can cause adverse effects to the patient, including elevated or decreased heart rate, nausea, vomiting, and diarrhoea, among others (Department of Health, 2012). It is important to manage these adverse effects in order to prevent any complications which may arise following the patient’s surgery. My actions helped ensure that no adverse effects manifested and if there were any adverse effects, they would have been managed immediately (Haugen, et.al., 2009). Moreover, my actions also helped ensure that there was no postoperative bleeding and infection. The important aspect of monitoring for these signs relate to early management of symptoms. Early management of postoperative complications is an important element of postoperative care (Cohen and Cesta, 2005). Nurses in the postoperative setting have to be vigilant about the aspects of care they have to administer to these postoperative patients. I was vigilant at all times in my patient monitoring and in the administration of the morphine, including the monitoring of the possible adverse effects that the morphine can bring (Dosa, et.al., 2008). My actions helped to ensure that the patient was adequately managed in the postoperative period. It also helped ensure that the patient did not manifest any postoperative complications (Lindley, et.al., 2009). It helped ensure that early management of patient issues would be made possible should these issues arise. My actions helped relieve patient anxiety; it provided emotional support for the patient thereby reducing the impact of the surgery (Lindley, et.al., 2009). In the end, I feel that I was able to carry out the essential elements needed in the postoperative management of the patient. III. Confronting Based on the incident described and discussed above, the main consideration for this incident were my actions during the administration of the controlled drug and my postoperative management of the patient. I was very much concerned about my inability to manage the patient during the postoperative period, especially in managing her pain. These are significant concerns because her recovery was primarily reliant on postoperative care and her recovery from her surgery (Lindley, et.al., 2009). Drugs are substances which are intended to cure, mitigate, treat or prevent disease. There are different types of drugs, mostly non-regulated, partially regulated, and controlled drugs (Daniels, 2004). Nurses are tasked with the administration of medications, mostly based on doctor’s orders. The administration of medications is a delicate process which requires a significant amount of vigilance on the nurse (Daniels, 2004). Failure of such vigilance can cause medication errors and can potentially be harmful, even fatal to patients. The monitoring of controlled drugs is especially delicate because these are drugs which carry the most risk in relation to overdose; they also have the highest potential in presenting adverse effects (Prasad, 2010). Medication errors can also occur in the administration of medications. These errors may include the following: wrong patient, wrong dose, wrong frequency, wrong route, wrong drug, and wrong time (Doran and Almost, 2003). These errors can potentially cause adverse effects for the patient, often exacerbating her condition and possibly endangering her life and in some cases other patients’ lives. Aside from medication errors, adverse or side effects can also present soon after medication administration (Doran and Almost, 2003). Some side effects are expected and no additional management of these symptoms are often needed. Other more severe side effects need additional management. Adverse effects often require the stopping of the medication or the adjustment of its dose; and sometimes, shifting to an alternate drug is also necessary for these patients (Cohen, 2007). Allergic reactions to drugs are also a primary consideration in the administration of medications. In the case of morphine, there are significant issues which can arise from the administration of the drug. Hence, it is important for nurses and other healthcare practitioners to know the possible adverse effects of the drug, how to manage these, and the protocol involved in their management (Prasad, 2010). Hospitals also have their protocols in the administration of morphine. These protocols often differ from hospital to hospital (Molter, 2007). Some hospitals highly regulate its administration, limiting the dose which can be administered in a day, with limits which may be less (not more) than the standard recommended daily dose for the drug (Wilson, 2006). Hospitals may also indicate that only certain nursing or medical personnel can administer the drug; this may contrast with other hospitals which may be more permissive on whomever administers the drug (Wilson, 2006). In the case of my hospital, they were not too restrictive on who administered the drug; nevertheless, only the staff nurses attending to the patient were allowed to administer the drug. Student nurses were allowed for as long as they were monitored and supervised by their mentors/staff nurses; in any case, these student nurses were only allowed to assist in the administration of the drug. They were also tasked with monitoring the patient after the administration of the drug. The important aspect which was noted in the management of the patient in the postoperative period was the correct and efficient administration of the pain medication morphine. Under these considerations, it was a revelation for me to note the importance of recognizing the patient’s rights in medication administration (Wood, 2008). Moreover, the importance of establishing parameters in medication administration is also a right of the attending nurse (Doran and Almost, 2003). These rights refer to the right for the nurse to have complete and clearly written orders on the specific drug, dose, route, and frequency of the drug. The nurse also has the right to expect correct dispensation of the drug from the pharmacy, especially in relation to dose and route (Doran and Almost, 2003). Access to drug information is also essential in the process of drug administration, including the right to secure policies and processes on safe drug administration. Where available, these elements help secure a safe environment from which patients, as well as for health professionals, can safely function (Doran and Almost, 2003). IV. Reconstructing In order to improve postoperative monitoring and medication administration, it is important to recognize the different elements of the practice which would help ensure patient management. It is important to gain as much information as possible about the possible postoperative needs of patients, including the indications and precautions for pain medications like morphine (Rosdahl and Kowalski, 2008). Patients seek providers who understand their needs, and can adequately manage their needs using the most appropriate and efficient interventions. It is therefore important for health professionals to be aware of the specific needs of the patient and the specific precautions which arise from the patient’s needs (Rosdahl and Kowalski, 2008). The nurse must gather as much data as possible, especially in relation to postoperative pain management, based on medically appropriate interventions (Rosdahl and Kowalski, 2008). Some of these interventions serve to provide comfort and care for the patients, thereby reducing the physical as well as the psychological impact of their illness, or in this case, their surgery. The nurses are expected to know which practices and interventions can safely be applied to the patient, and which practices cannot (Spry, 2009). The patient can also be a source of information on what practices and interventions would be considered applicable to her. It is therefore important to include the patient in the planning of care, paying particular attention to non-pharmacological interventions which can be carried out as independent nursing interventions (Spry, 2009). This incident has helped improve my nursing skills, especially in medication administration. It helped stress upon me the importance of vigilance in my duties in patient care. It taught me the importance of checking, double-checking, as well as evaluating patient needs in the eventual administration of efficient patient care (White and Duncan, 2002). The knowledge I gained helped arm me with the necessary tools in order to improve my practice and my academic knowledge. Through this incident, I was able to understand the gaps in my knowledge as well as the necessary improvements which needed to be carried out in order to successfully secure improved patient outcomes (Taylor, 2000). I intend to use the knowledge I have gained during this incident in order to enhance my patient care, especially in terms of medication administration and postoperative care. References Coakley, A. and Duffy, M., 2010. The effect of therapeutic touch on postoperative patients. J Holist Nurs, 28(3), pp. 193-200. Cohen, M., 2007. Medication errors. New York: American Pharmacist Association. Daniels, R., 2004. Nursing fundamentals: caring & clinical decision making. London: Cengage Learning. Department of Health, 2012. Nurse and pharmacist independent prescribing changes announced [online]. Available at: http://www.dh.gov.uk/health/2012/04/prescribing-change/ [Accessed 10 December 2012]. Doran, D. and Almost, J., 2003. Nursing sensitive outcomes: the state of the science. London: Jones & Bartlett Learning. Goldsworthy, S., 2007. The effectiveness of simulation on self efficacy and medication administration safety for undergraduate nursing students. Sigma Theta Tau International Hardwick, M., 2009. Use of healing touch as a nursing intervention for pain in bilateral total knee arthroplasty. Sigma Theta Tau International Haugen, A., Eide, G., Olsen, M., and Haukeland, B., 2009. Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia. Journal of Clinical Nursing, 18(16), pp. 2301–2310. Hurley, A., 2006. Perceptions about the medication administration process. Eastern Nursing Research Society. Keohane, C., Bane, A., Featherstone, E., and Hayes, J., et.al., 2008. Quantifying nursing workflow in medication administration. Journal of Nursing Administration, 38(1), pp. 19-26 Leinonen, T., Leino-Kilpi, H., and Jouko, K., 2008. The quality of intraoperative nursing care: the patient's perspective. Journal of Advanced Nursing, 24(4), pp. 843–852. Lindley, P., Pestano, C., and Gargiulo, K., 2009. Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective. Journal of Advanced Nursing, 65(7), pp. 1370–1380. Molter, N., 2007. AACN Protocols for Practice: creating healing environments. London: Jones & Bartlett Learning. National Institute for Health and Clinical Excellence, 2008. Surgical site infection: Prevention and treatment of surgical site infection [online]. Available at: http://www.nice.org.uk/nicemedia/pdf/CG74NICEGuideline.pdf [Accessed 10 December 2012]. Prasad, J., 2010. Conceptual pharmacology. New York: Universities Press. Rosdahl, C. and Kowalski, M., 2008. Textbook of basic nursing. London: Lippincott Williams & Wilkins. Royal College of Nursing, 2011. Standards for assessing, measuring and monitoring vital signs in infants, children and young people [online]. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0004/114484/003196.pdf [Accessed 10 December 2012]. Spry, C., 2009. Essentials of perioperative nursing. London: Jones & Bartlett Learning. Taylor, B., 2000. Reflective practice. UK: McGraw-Hill International. White, L. and Duncan, G., 2002. Medical surgical nursing: an integrated approach. London: Cengage Learning. Wilson, I., 2006. Oxford handbook of anaesthesia. Oxford: Oxford University Press. Wood, S., 2008. Investigations and pain management guidelines. Nursing Times [online]. Available at: http://www.nursingtimes.net/nursing-practice/clinical-zones/pain-management/investigations-and-pain-management-guidelines/1861192.article [Accessed 10 December 2012]. Read More