Post-Operative Care - Case Study Example

Introduction Post-operative care focuses on a range of nursing activities, which include assessment of the patient, monitoring and intervention, providing emotional care to the patient and his or her family, communicating patient information to the surgeon and providing discharge plan for the patient (Buttaro& Barba, 2012). The objective of post-operative care is to minimize complications that may occur after the operation by carefully monitoring for any subtle changes as well as anticipating and preparing for any serious complications that may occur suddenly such as heart failure, stroke or pulmonary oedema (Buttaro& Barba, 2012). This essay discusses the assessment, monitoring and interventions including rationales that can be made for the Alma after the surgical procedure. Assessment - Acute pain relates to reflex muscle spasms and surgical incisions and can be identified from facial grimacing, moaning and irritation, complaints of pain, tachycardia, restlessness, tense and guarded body posture and diaphoresis. Interventions and Rationales - The pain location, intensity, duration and the kind of movement/action she was doing when the pain started as well as the effects of relief measures will be assessed in order to determine correct interventions. Pain occurrence depends on the size and location of surgical incision, abdominal distension, muscle stretching, internal manipulation and the positioning of the patient in the operating room. Patient-controlled analgesia (PCA) will be administered to relief pain. Activity level will also be enhanced by providing diversionary activities that distract the patient from the pain (White, Duncan, &Baumle, 2012). Non-pharmacological pain management techniques such as imagery, relaxation, positioning, massage and distraction will be used to enhance the effects of pharmacological products. Expected outcomes - The patient will express satisfaction with the pain relief and there will be no complications in recovery process following the operation. Assessment – The patient may have nausea or vomiting that relates to the effects of anaesthesia or gastrointestinal medication and distension, which are manifested by feelings of nausea, vomiting or the rejection of solid food or fluids. Interventions and rationales - The precipitating factors such as pain, unpleasant sights and smells are identified and removed where possible to avoid instigating nausea or vomiting (Perry et al., 2013). Nasogastric tube drainage will be maintained to prevent the build-up of gastric fluids and consequent vomiting. It may be necessary to administer antiemetic’s, tissues and bowels for vomiting should be kept in a location the patient can easily access. Bowel sounds will be assessed to establish their presence, characteristics and frequency. The gastrointestinal effects of drugs especially narcotics will be monitored to determine the potential cause of nausea. The advance diet will be administered using PCA to prevent gastrointestinal distension (Perry et al., 2013). Fluid intake and output such as IV fluids, wound drainage, urinary output, nausea/vomiting and nasogastric tube drainage will be monitored. IVI N Saline will be administered at 125mls per hour as ordered. Blood pressure and pulse rate will also be assessed. Expected outcomes – Nausea and vomiting will be reduced and there will be less interference with post operation recovery. Assessment – The presence of stoma ischemia and necrosis may relate to twisting of the bowel conduit during the operation, tension on the blood vessels or inefficiency of the arteries. Intervention and rationale – The stoma is inspected every four hours to ensure the blood supply is adequate. The stoma should be oink or red, but the colour changes to brown, black or purple if the blood supply is compromised. The changes are reported immediately to the surgeon who inspects lumen tube for superficial necrosis or ischemia by inserting small lubricated tube into the stoma. A necrotic stoma may require surgical intervention (Brunner &Smeltzer, 2010). Assessment – There may be a risk of infection related to inadequate fluid intake and nutrition, invasion by pathogens and lack of mobility. Intervention and rationale - Vital signs will be recorded according to the record keeping guidelines. Personal digital assistants will be used to record data and to provide early warning scores for analysis. If the conditions of the patient are deteriorating, the information will be passed on to the doctor in charge using the situation, background, assessment and recommendation tool (Hardin &Kaplow, 2010). Vital signs such as temperature and general appearance of the stoma are inspected. Changes in vital signs indicate the possibility of presence of an infection. The signs include rise in white blood cell count, increase in respiratory and pulse rate, rise in the body temperature, warm, redness and swollen surrounding the incision area, purulent discharge from the wound and invasion lines. Aseptic method is used to provide wound care which includes sterile dressing, hand washing, and drainage devices are emptied to prevent the wound from being contaminated. Antibiotics can be administered if ordered. The patient is also assisted to breathe deeply, turn and cough in an interval of 1 to 2hrs to prevent infection of respiratory systems (Hardin &Kaplow, 2010). Expected outcomes - The patient will be free from infection, swelling in the surgical site, pain, purulent wound discharge and fever. Assessments - Ineffective airway clearance relates to the inability to clear secretions, which can be identified from shallow breathing, inadequate coughing, low oxygen saturation and abnormal breathing sounds. Intervention and rationale - Respiratory status will be assessed frequently. This includes assessment of lung sounds (auscultation) and chest excursion as well as the presence of an adequate coughing (White, Duncan, & Baumle 2012). The patient will be provided with pain relief prior to having her breathe deeply or cough to reduce pain during the performance. She will then be assisted to breathe deeply, turn and cough at intervals of 1 to 2 hours to aid in liquefying the secretion for easy removal and to prevent the formation of mucus. The patient’s temperature and breathing sounds will be monitored to detect infection or postoperative complications as early as possible. The patient will also be assisted to move to increase perfusion and ventilation in the lungs (Cooper & Gosnell, 2015). The patient’s respiratory function will be assessed by monitoring the pattern, rate and depth of respiration. Oxygen saturation will be assessed to ensure that oxygen running at 3L per minuteis maintained via nasal prongs. Respiratory function and rate are among the first vital signs that can indicate a change in neurological or cardiac conditions. Therefore, it is important to observe their performance accurately. The patient will be assisted to stand, breathe deeply and change position frequently to encourage self-care (Cooper & Gosnell, 2015). Expected outcome - Breathing sounds will be clear and coughing will be effective. Assessment - Listening to the comments made by the patient which indicate insecurity and depression. The patient may be looking at the stoma or incision and express concerns about it. The patient may be overwhelmed and devastated by the illness and she may express gladness to be alive (Fogel& Greenberg, 2014). Intervention - One of the interventions is to listen to the patient and be attention to her behaviour, ensuring that negative feelings are not reinforced. The patient will also be assured that depression and anxiety are normal. She will be encouraged to participate in self-care, and she will be prepared to expect comments and reactions from friends and family members. The family and the patient will be provided with psychological counselling, which may continue after discharge (Fogel& Greenberg, 2014). Q2. Potential problem/complication Haemorrhaging related to changes in coagulation or unsuccessful vascular closure. Intervention and rationale - The surgical site will be monitored and dressed every 15 minutes for the first four hours, with the time interval increasing thereafter, to detect any sign of bleeding at early stages. Vital signs will be monitored regularly to detect signs of hypovolemia. Blood pressure will also be monitored, and any abnormalities such as an increase in respiration and pulse rate, the presence of fresh blood when dressing, low blood pressure, low body temperature and clammy skin, will be reported. The amount and colour of wound discharge will be assessed. If a large amount of fresh blood is found, there may be haemorrhaging. If wound drainage is absent, it is important to ensure that the drain is still in place (White, Duncan, &Baumle, 2012; Cooper & Gosnell, 2015). Any change in brain status, such as a sense of impending danger or restlessness, will be reported, as this is an indication of insufficient cerebral perfusion. Coagulation function tests and platelet levels will be monitored since changes may be an indication of bleeding. The levels of haemoglobin will also be monitored because low levels are indicative of haemorrhaging. The cardiac and renal systems will also be observed to identify changes and minimise complications as early as possible. Accurate records of weight, blood pressure, intake and output and blood urea will be taken, and they can be used to analyse renal status. If the patient’s condition is found to be deteriorating, all information will be passed on to the doctor in-charge using the situation, background assessment and recommendation tool (White, Duncan, &Baumle 2012). The nurse can prevent haemorrhage from happening by monitoring the operation site for signs of haemorrhaging and identifying any deviations from acceptable parameters. The nurse will also carry out appropriate medical and nursing interventions such as initiating treatment to stem the bleeding, maintain the patient’s airway and restore cardiovascular stability. Saline and other IV fluids will be administered through an intravenous catheter. In some cases, this may require the administration of packed red cells as ordered to restore the oxygen carrying capacity of blood cells. However, in acute cases, fresh whole food is administered as it contains clotting factors and can restore blood components (LeMone et al., 2015). Q3. Discharge plan Discharge plan involves comprehensive assessment to ensure that the patient have a smooth move from the hospital care to home care setting (Williams & Hopper, 2015). Physical factors which may interfere with the ability of the patient to manage post operation care are identified. The interaction of the patient with the family is assessed, to ensure that someone take care of her. The possibilities of the patient requiring the post hospital services and the accessibility of the services are evaluated. In addition, the patient capacity for self-care or the possible environment in which the patient care be cared for are also identified. Evaluations on time basis are completed so that suitable plan for care outside the hospital can be made before the discharge and to avoid unnecessary delays during discharge. It is also ensured that the discharge plan evaluation is included in the patient’s medical record that is used to determine the suitable discharge plan that include the outcome of the evaluation with patient (Powell et al., 2008). Before discharge, it is ensured that the patient display stable signs such as no nausea or vomiting, no bleeding, have controlled pain that is not severe and can be able to sit up without feeling dizziness (Williams & Hopper, 2015). A caretaker should be involved in the discharge instruction plan in order to understand the observations to be made and what to do in case a complication arises. The patient should avoid making major decisions, driving, drinking alcoholor driving in the next 24 hours because the energy and thinking ability is affected by surgical process. The patient is also taught on how to care for the wound, effects of medications, signs and symptoms of complications that can be reported to the health professional. The phone numbers of the emergency care and surgical facility are provided (Williams & Hopper, 2015). Conclusion Complications can be minimized by carefully monitoring for any subtle changes and anticipating and preparing for any serious complications that may occur suddenly such as heart failure, stroke or pulmonary oedema. Nursing interventions include assessment, relieving pain, administering medications, managing fluid, monitoring nutritional status, maintaining skin integrity, promoting normal bowel elimination, preventing wound infection and teaching the patient. The patient is discharged when she is not experiencing any postoperative complications, many of which can be identified or prevented if the signs and symptoms are monitored thoroughly. References Buttaro, T. M., & Barba, K. A. (2012). Nursing care of the hospitalized older patient. New York, NY: John Wiley & Sons. Brunner, L. S., & Smeltzer, S. C. O. C. (2010). Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Cooper, K., & Gosnell, K. (2015). Foundations and adult health nursing, St. Louis, Missouri: Elsevier/Mosby Fogel, B. S., & Greenberg, D. B. (2014). Psychiatric care of the medical patient, New York: Oxford University Press. Hardin, S. R., &Kaplow, R. (2010). Cardiac surgery essentials for critical care nursing. Sudbury, Mass: Jones and Bartlett Publishers. LeMone P., Burke K., Dwyer T., Levett-Jones T., Moxham L., & Reid-Searl K. (2015). Medical-surgical nursing. Pearson Higher Education AU. Perry, A. G., Potter, P. A., &Ostendorf, W. (2013). Clinical nursing skills & techniques, St. Louis, Missouri: Mosby/Elsevier. Powell, S. K., Tahan, H. A., & Case Management Society of America. (2008). CMSA core curriculum for case management. Philadelphia: Lippincott Williams & Wilkins. White L., Duncan G., &Baumle, W. (2012). Medical surgical nursing: An integrated approach. Cengage Learning Williams, L., & Hopper, P. (2015). Understanding medical surgical nursing. Philadelphia: F.A. Davis Company. Read More