Gastroscopy, Bleeding, Infection - Assignment Example

NSG2ACA Special Assignment 2014 Name of Student Lecturer Date Question 1 Most favorable management of a patient in the entire postoperative stage requires right clinical assessment and monitoring. In deed, postoperative care needs pre-emptive management. This involves normal assessment, selective monitoring, as well as timely documentation. One of the main objectives of postoperative nursing care is to evaluate the patient’s needs which help nurses to provide personal and holistic care postoperatively (Gunningberg & Idvall, 2007). Immediately Ann returned to the ward, she would potentially require supplement oxygen, restoration of consciousness, pain management and fluid replacement. Depending on the assessment by the nurse in regard to respiratory rate and the level of oxygen saturation, Anne would require to be provided with supplemental oxygen in case she has lower oxygen saturation (Ene et al., 2008). Therefore, it would be demanding to give supplemental oxygen therapy to the patient. The nurse would ensure he or she maintains more than 95% oxygen saturation levels so to prevent hypoxia. In addition, the oxygen saturation in Ann should be monitored by the nurse because it can easily result to respiratory failure (Scottish Intercollegiate Guideline Network, 2005). This is the first requirement that should be met so to maintain the life of the patient. Lower oxygen saturation leads to breathing problems and this can easily endanger the life of the patient The second requirement by Anne is likely to be the need to gain consciousness. Also this will depend of the result the nurse gets after assessing her level of consciousness, orientation, as well as whether or not she can move extremities (Scottish Intercollegiate Guideline Network, 2005). This is also a bad situation and immediate action should be taken to restore the patient to normal. Therefore, the nurse attending to Anne would have to apply appropriate interventions and continue to monitor the patient until she stabalise. Fluid replacement is the third patient need Anne would experience after she returned to the ward within the time frame. The nurse concerned should assist replace fluids as well as electrolytes Ann lost during the surgical procedure (Scottish Intercollegiate Guideline Network, 2005). Some of the reasons why Anne would experience fluid imbalance after the procedure include pre-operative fasting times, infiltrated cannula, bowel preparations and poor prescription of fluids (Scottish Intercollegiate Guideline Network, 2005). Fluid replacement is particularly important since it would make sure sufficient hydration is equivalent to safe practice by the nurse. It would also prevent the patient from being dehydrated further allow her body to function normally. The last patient’s need which is basically important is pain management. However, before tying to manage pain, the nurse would first assess the level of pain, timing, and its characteristics in terms of location and quality (Gunningberg & Idvall, 2007). The post operative pain Anne experiences should be relief using local anaesthetic blocks, PO opioids or PR non-steroidal anti inflammatory drugs among others. Normally, the moment the surgical procedure is performed, the pain in the nerves is higher a few hours later. Pain which is not treated can cause more harm to the patient (Ene et al., 2008). Therefore, pain control would help promote not only the wellbeing, but also the recovery of Anne. Although it may not be a priority compared to the previous needs, it can not be ignored at all. Question 2 Referred pain is the pain a patient feels at a site away from the original site of pain. This type of pain mainly occurs in patients with chronic musculoskeletal pain, such as chronic low back pain, fibromyalgia, and temporomandibular (Murray, 2009). Referral pain is believed to have a neural basis. Neural connections and particular pathways in the brain are considered to lead to likelihood of pain referral. One of the important neural phenomena that bring about pain referral in human body is convergence, which involves how the brain receives and processes sensory information (Murray, 2009). However, referral pain can also be experienced by a person who has undergone a laparoscopic surgical procedure in different ways. According to Brandsborg (2012) prevalence rates of pain in patients who have undergone laparoscopic surgery varies from 5-32%. Nevertheless, a person usually experiences pain in areas, such as area of incision, pain in between blades of the shoulder, the lower back, and the pelvis. Normally, the gas used to distend an individual’s abdomen for the surgery gets absorbed gradually into the blood stream. This occurs over the first 3 to 4 days after laparoscopic surgical procedure (Costigan, Scholz & Woolf, 2009). The gas is not passed intestinally, but since the abdomen is distended, it may possibly experience the same intestinal gas. In addition, immediately after a surgical procedure, the pain in the nerve is more intense for the first 6-12 hours (Nikolajsen & Minella, 2009). When the body starts to heal, inflammation is created around the surgical incision location which adds pressure and creates soreness. Also, sudden pull in the surgical incision through for instance coughing may reactivate the nerve pain which can spread to other parts of the body. Therefore, a patient who has undergone laparoscopic surgery may occur in a combination of neuropathic and inflammatory pain (Brandsborg, 2012). It is likely that it is the neuropathic component that plays a significant role for the sensitization and maintenance of pain individuals who have undergone a laparoscopic surgery procedure. Question 3 Gastroscopy is an accurate test used to examine the lining of a person’s upper digestive track so to establish presence of any disease. However, before the procedure begins a person should receive nursing care by a qualified nurse. First, the nurse should meet Martin and ask him a few questions concerning himself and his condition. The nurse could ask probably ask Martin about his arrangements for getting home. The nurse could as well ask more questions about his or her investigations (Shepherd, Cramp & Hewett, 2006). This will help prepare Martin for the procedure. During this time, the nurse should ensure Martin understands the procedures and discuss his main concerns. As Martin will be having sedation, the nurse should insert a small cannula into a vein in either of his hands through which to administer sedation later (Shepherd et al., 2006). The qualified endoscopy nurse will then perform a brief medical assessment where he or she will ask Martin some questions concerning his medical condition. The nurse should also remember to question about any illness or surgery Martin has had before (Christie NHS Foundation, 2012). This is meant to confirm that Martin is ready to undergo the investigation. In the process, the nurse should record the heart rate and blood pressure. In case Martin is diabetic, it would necessary for the nurse to also record his level of blood glucose (Shepherd et al., 2006). In addition, if he experiences breathing problems, the nurse should record his level of oxygen. The nurse will also administer an intravenous sedation to make Martin drowsy and relaxed, but will remain conscious (Christie NHS Foundation, 2012). Therefore, Martin will be able to hear what the nurse tells him and follow simple instructions when investigation is administered. Sedation makes it unlikely that Martin will remember anything concerning the gastroscopy procedure (Christie NHS Foundation, 2012). During the sedation, the nurse should check Martin’s breathing and heart rate and note any changes to deal with them accordingly (Shepherd et al., 2006). Thus, the nurse has to connect Martin by a finger probe to a pulse oximeter which will be used to measure his levels of oxygen and heart rate during gastroscopy. Question 4 Infection takes place in about 35% of grossly contaminated wounds and 4% of clean wounds (Meeks & Trenhaile, 2004). For this reason, the incision in Ying’s abdomen should be prevented from infection through a number of nursing interventions. The wound should be dressed up to promote healing by protecting the wound from harmful agents and providing a moist environment (Meeks & Trenhaile, 2004). The nurse may use wet-to-dry gauze dressing, whereby the gauze will be moistened with tap water of normal saline, placed into the wound and then covered using dry layers of gauze. Upon the moistened gauze drying out, it will adhere to surface tissues to be removed when changing the dressing (National Collaborating Centre for Women’s and Children’s Health, 2008). Thus, dressing up the wound will protect it from infections within this period. In addition, the nurse should use clean dressing techniques to prevent microorganisms from getting in contact with the wound. The wound should also be cleansed using sterile saline solution. A part from improving the wellbeing of the patient, cleansing will be used to remove excess wound excretions that could facilitate contamination. According to National Collaborating Centre for Women’s and Children’s Health (2008) the nurse should use sterile saline to cleanse wound up to 48 hours from the time of surgery. In addition, the patient should be advised to shower safely within the time frame of the first 72 hours, for instance, he should not allow spray have direct contact with the incision. The nurse should also advice Ying when to he can shower. The wound could also be protected from infection through irrigation. This involves the use of a syringe containing saline solution to apply irrigation to remove clots and other dead tissues (Meeks & Trenhaile, 2004). Saline solution is encouraged because it odes not affect the normal process of healing. Question 5 Bleeding is a common phenomenon, but heamorrhage is a rare. Haemorrhage is the excessive bleeding that is usually difficult to stop. Therefore, it is important to perform nursing assessments so detect and prevent this from happening (Department of Health and Human Services, 2009). Normally, when an individual starts to haemorrhage it is not easy to tell how serious the situation will be. Similar to other palliative care situations, the nurse can anticipate the possibility of haemorrhage. Some types of cancer and health conditions are more likely to lead to haemorrhage (Smith, 2007). The nurse should be able to tell whether Ying is at risk of internal bleeding or external bleeding during the assessment. To determine if the bleeding is internal, the nurse should monitor Ying’s body condition. These according to Department of Health and Human Services (2009) include loss of consciousness, sudden tiredness and weakness, rapid breathing and heart rate, restlessness and sudden irritability, and the skin becoming pale, cold and clammy. The nurse should also assess the possibility of dislodgement of the clot, rolling of a ligature or cessation of reflex vasospasm in the patient. The precipitating factors are restlessness, vomiting and coughing which usually increases the venous pressure (Lange, 2009). Another factor is when the venous system is refilled on recovery from shock and the increase in blood pressure. All these precipitating circumstances should be assessed to determine the likelihood of Ying’ wound leading to haemorrhage (Smith, 2007). The nurse may also detect wound haemorrhage by observing the appearance of bright red stains of the wound dressing. This is normally followed by an immediate rigorous haemorrhage which is likely to be fatal. The reason why the possibility of this situation arising assessed and detect is due to the fact that there is little warning it is just about to occur (Department of Health and Human Services, 2009). This would put the life of Ying in danger, especially when the bleeding would be internal or hidden and this would cause his condition to suddenly deteriorate. Question 6 Unlike the normal uncut skin, a surgical incision does not attain similar cutaneous tensile strengths after suturing. Sutures in a surgical incision are foreign bodies and generate an inflammatory response in the site of the incision, there should be removed within the prescribed time frame, for instance in this case in the next 12 to 14 days. Sutures should be removed between this time so to prevent or reduce suture marks and suture reaction. Also, they have to remain in the surgical incision up to at least 12 days as indicated to prevent the scar from spreading and wound dehiscence (Kudur et al., 2009). According to Kudur et al. (2009) sutures in different sites on human body are removed within different time frames. Sutures in surgical incisions performed on trunk and extremities should be removed in a period between 10 to 14 days. When removing sutures in a site of surgical incision, there are factors that must be considered to ensure the process is safe and secure. The person removing the sutures should first clean the suture line using an antiseptic. This is meant to ensure the surgical incision is protected from infection (Kudur et al., 2009). Also, the individual should be carefully when selecting the suture material to use to perform the exercise. The selection of suture material should be based on the static and dynamic tension of the wound, location of surgical incision, cost of suture material and presence of surgical incision infection. In case there is more likelihood of infection of fever in the surgical incision, deed sutures made up of synthetic monofilament sutures may be used (Kudur et al., 2009). Braided sutures may not be appropriate because they are related with advanced rates of infection, thus they are likely to be more degraded by fever or infection. The person removing the suture should grasp the interrupted suture by use of fine forceps at the knot which should then be cut on its opposite side at the point where suture enters into the skin (Kudur et al., 2009). This should be done carefully to avoid damaging the surgical incision. Afterwards, the suture should be tenderly drawn out by pulling toward the edge of the wound (Kudur et al., 2009). When using a running suture technique, suture should be removed by cutting its loops and taking hold of the intervening loop using forceps as it is pulled out. During the removal of suture in Ying’s surgical incision, the suture needles used to accomplish the exercise should be handled with a lot of care. The cutting point of the needles should not be blunted and the weaker end of the suture needle should never be bended (Kudur et al., 2009). In addition, the suture needles should be grasped using needle-holders. This is important as it would help keep the surgical incision free from infection and any kind of contamination. The type of suture needles to use may be selected based on their size, shape and cross-section (Kudur et al., 2009). For instance, the size of the suture needles should be thin enough with fine filament that the surgical incision can tolerate. It is also important to consider the type of suturing techniques to use to remove the sutures from Ying’s wound. The suturing technique chosen should able to minimise tension that may cause separation in the wound and remove dead space existing in the subcutaneous tissues (Kudur et al., 2009). This incorporates right wound placement with regard to tension lines that are relaxed. It should be note that this and other factors discussed above will influence the outcome of the process therefore right decisions should be made to ensure its success. References Brandsborg, B. (2012). Pain following hysterectomy: epidemiological and clinical aspects. Lung, 5(18), 43. Costigan, M, Scholz, J, Woolf, C.J. (2009). Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 32(1), 1-32. Department of Health and Human Services. (2009). Haemorrhage and bleeding: Emergencies in Palliative Care. Ene, K. W., Nordberg, G., Bergh, I., Johansson, F. G., & Sjöström, B. (2008). Postoperative pain management–the influence of surgical ward nurses. Journal of clinical nursing, 17(15), 2042-2050. Gunningberg, L., & Idvall, E. (2007). The quality of postoperative pain management from the perspectives of patients, nurses and patient records. Journal of nursing management, 15(7), 756-766. Kudur, M. H., Pai, S. B., Sripathi, H., & Prabhu, S. (2009). Sutures and suturing techniques in skin closure. Indian Journal of Dermatology, Venereology, and Leprology, 75(4), 425. Lange, F. (2009). Nursing management of subarachnoid haemorrhage: A reflective case study. British Journal of Neuroscience Nursing, 5(10), 463-470. Meeks, G. R., & Trenhaile, T. (2004). Surgical incisions: prevention and treatment of complications. Murray, G. M. (2009). Guest Editorial: referred pain. Journal of Applied Oral Science, 17(6), 0-0. National Collaborating Centre for Women’s and Children’s Health. (2008). Surgical site infection: Prevention and treatment of surgical site infection, ISBN 978-1-9047-52-69-1. Nikolajsen, L, Minella, C.E. (2009). Acute postoperative pain as a risk factor for chronic pain after surgery. Eur J Pain Suppl. (3), 29-32. Scottish Intercollegiate Guideline Network. (2005). Postoperative management in adults: A practical guide to postoperative care for clinical staff, ISBN 1 899893 09 1. Shepherd, H., Cramp, S., & Hewett, D. (2006). Gastroscopy and Colonoscopy: Combined Oesophago-gastro duodenoscopy (OGD) and Colonoscopy. Winchester: Hampshire. Smith M (2007) Intensive care management of patients with subarachnoid haemorrhage. Curr Opin Anaesthesiol, 20(5): 400–7. The Christie NHS Foundation. (2012). Having a gastroscopy: A guide for patients and their carers. Read More