Nursing the Surgical Patient - Case Study Example

Nursing the Surgical Patient Student’s Name Institutional Affiliation Nursing the Surgical Patient Introduction – The Scope of Case Study The case study – 2 succinctly describes the life threatening condition of a 40 years old patient affected with bowel carcinoma and other clinical co-morbid states attributing to diabetes and colostomy status. The complex care requirement for this patient warrants the utilization of proactive nursing approaches for mitigating the clinical manifestations of the patient inside the healthcare setting. The terminal condition of this patient requires the administration of palliative and person-centered interventions for enhancing the psychosocial health and wellness pattern across the community environment. Post surgical status and high intensity of patient’s pain advocate the requirement of developing a supportive environment by nursing professionals to enhance her compliance with the recommended medical interventions. The case study also advocates the requirement of undertaking psychosocial interventions for stabilizing the stressful condition that the patient experiences under the influence of her life threatening morbidities and co-morbid states. Thesis Statement: This essay emphasizes the effective nursing interventions that are necessarily required for enhancing the health, quality of life and psychosocial patterns of a 40 years old patient during the postoperative period following the surgical intervention of left hemicolectomy. The essay advocates the requirement of delivering person-centered and holistic interventions in the context of customizing the nursing care assistance for the patient affected with the terminal condition of colon cancer. The Nursing nIterventions and their Rationale The post-operative nursing care must employ evidence-based techniques for increasing the participation of patient in formulating the nursing interventions (Jonsson, Stenberg, & Frisman, 2011). The nurses require extending psychosocial support to the patient while empowering her in terms of expressing contentions regarding the proposed clinical approaches for controlling the intensity of disease manifestations. Portions of the colostomy device attributing to the plates and pouches require regular replacement by the nursing professionals in the context of reducing the risk of infection across the colostomy location following the facilitated elimination of the fecal content (Muzyczka, et al., 2013). Evidence-based research literature documents the early manifestations of colostomy experienced by patients following hemi-colectomy intervention (Liu, et al., 2012). These manifestations include the events of hemorrhage, organ injury, stenosis of the colostomy, hernia and pyogenic infection. Therefore, nursing interventions in terms of maintaining the colostomy location highly required for avoiding the risk of developing debilitating complications following the surgical intervention. These nursing interventions (for avoiding the occurrence of colostomy manifestations) attribute to the regular cleansing of colostomy location with the implementation of sterile techniques by nurse professionals. Research findings by (Geiger & Muldoon, 2011) advocate the contention attributing to the fact that patients affected with the pattern of obesity remain predisposed to the development of colostomy complications during the postoperative tenure. Furthermore, the risk of developing additional complications attributing to hernia, wound dehiscence, thromboembolism, and pulmonary and cardiovascular complications requires regular monitoring of Alma in terms of recording the outcomes of administered medications and evaluation of IV line to reduce the scope of subsequent operative intervention following the appearance of secondary symptoms (Geiger & Muldoon, 2011). The clinical scenario describes the state of patient’s diabetes that elevates the risk of metabolic manifestations and bedsores during the length of Alma’s stay inside the medical facility. The development of skin manifestations, necrosis and patterns of ischemia attribute to the prognostic outcomes in colostomy patients affected with diabetes and circulatory manifestations (Kwiatt & Kawata, 2013). Therefore, nursing interventions in terms of educating the patient regarding the severity of her cancer condition, colostomy status and co-morbid states required for enhancing the pattern of self-care after postoperative intervention inside the clinical medical facility. As the patient survives on oxygen and medication administration during the postoperative care, the nursing professionals require undertaking hemodynamic evaluation of patient and ventilation administration while monitoring the adverse outcomes of the treatment regimen during the course of postoperative intervention (Grade, Quintel, & Ghadimi, 2011). The pattern of patient’s diabetes mellitus (during the postoperative tenure) requires the effective administration of control measures by the nursing professionals in the context of controlling hyperglycemia and associated clinical complications that might adversely affect the somatic stability of the patient during the course of treatment intervention. Nurses require monitoring of patient’s liver glucose outcome and a-1c levels following the regular administration of drugs like "Metformin" or "Pioglitazone" during the therapeutic intervention (Giovannucci, et al., 2010). Recording of treatment complications in terms of episodes of hypoglycemia necessarily required for enhancing the wellness patterns and life expectancy of the patient following the course of medical-intervention. The existence of patient’s vacu-drain adjacent to the site of suture indicates the requirement of consistent suction of fluid and blood at the site of surgical intervention in the context of surpassing the probability of development of integumentary infection (Donna, Ignatavicius, & Workman, 2016). Defects in wound healing and dehiscence result in the development of infection at the site of surgical wound and therefore, deployment of closed vacu-drain by nursing professionals warranted in the context of suctioning-out the infected fluid for avoiding the development of infectious abscess and related conditions. The nursing professionals require regularly cleaning the vacu-drain system and examining the collected fluid and blood to identify the risk of development of infectious processes during the course of postoperative-interventions. The administration of patient controlled anesthesia (PCA) to Alma executed during the postoperative interventions for controlling the intensity of pain that she experienced following the hemi-colectomy procedure. Consistent monitoring of patient during the administration of PCA highly required for identifying the adverse outcomes and their corresponding clinical interventions for safeguarding the wellness pattern of the patient across the clinical setting (Allbee, et al., 2010, p. 123). The competent nurse professional requires undertaking dose adjustment of PCA drugs for avoiding the episode of extra sedation of the concerned patient. The qualified nurse also requires tracking and monitoring the vital signs of the patient regularly for reporting any inadequacy to the treating physician in the context of administering remedial measures for mitigating the instability in vitals as well as abrupt constitutional outcomes. The registered nurse professional requires organizing bedside counseling sessions with the patient for enhancing her knowledge regarding the requirement as well as method of administering PCA during the course of postoperative care. This will reciprocally enhance the self-sufficiency of the patient in terms of administering self-controlled analgesia while requiring minimum assistance from the nurse professional. However, vigilantly monitoring the consciousness level of the patient and the pattern of her compliance to the PCA intervention necessarily warranted in the context of surpassing the probability of inappropriate dose administration during the postoperative care. PCA dose adjustment is frequently required in Alma’s case in relation to the pattern of her obesity and diabetes mellitus. Therefore, despite undertaking a training session for the patient, the nurse professional requires vigilantly tracking the events of PCA mismanagement for reducing the probability of adverse clinical manifestations. The presented clinical scenario presents the requirement of undertaking stress management interventions by the nurse professionals for the patient in the context of reducing her state of distress and discomfort following the surgical intervention of hemi-coletomy and configuration of colostomy across the clinical setting. Evidence-based research literature describes stress management as the best nursing practice for enhancing the state of psychosocial health of the patients affected with the pattern of colorectal malignancies (Clark & Paraska, 2014, p. 548). The terminal condition and associated clinical co-morbid states of Alma indicate the unstable condition of her immune system that experiences the risk of further deterioration with the elevation in stress and anxiety during the postoperative period. Resultantly, the nurse professional requires configuring therapeutic relationship with the patient in the context of elevating her compliance to the proposed therapeutic interventions, increasing the state of her psychosocial health, extending dietary measures for mitigating the nutritional instability and instilling the pattern of hope, confidence and positive attitude in patient for enhancing her quality of life and associated wellness outcomes. Prospective Clinical Complication of the Case Study and Nursing Interventions The prospective complication that the patient might experience in relation to her postoperative colostomy care attributes to the development of colonic perforation. This clinical complication is the direct result of inadequate maintenance of colostomy location, including improper irrigation and catheter administration procedure that reciprocally lead to the development of perforation in the large intestine. Symptoms attributing to the development of colon perforation include peptic ulcer, colon trauma and inflammatory bowel disease identified by patterns of abdominal pain, nausea, vomiting and hematemesis (Coppolino, et al., 2013). The nurse professional requires implementing conservative approaches for reducing the clinical symptoms of colon perforation during the postoperative tenure of patient’s treatment. Intravenous administration of electrolytes and antibiotics, and establishing the rest-pattern of bowel attribute to some of the significant nursing interventions for challenging the progression of colon perforation while undertaking postoperative care of the patient following the hemi-colectomy procedure (Lohsiriwat, 2010). The patient also might experience the episodes of fecal incontinence and constipation following colonic pathology that requires administering nursing interventions for reducing the state of clinical complications during the postoperative tenure. The nursing professional requires administering stool softeners to facilitate the evacuation of impacted fecal matter with the administration of the catheter through patient’s colostomy. The regular tracking of patient’s bowel patterns highly required in identifying the extent of colonic perforation for its clinical management. Furthermore, the nurse professional requires administering a high fiber diet to the patient in the context of reducing her predisposition towards the development of patterns of diverticulitis in association with colonic perforation (Christensen & Kockro, 2011). The administration of antiemetic and antispasmodic drugs interventions warranted by the nursing professionals in the context of nausea, vomiting and abdominal pain following the episode of colonic perforation. The preventive measures, for reducing the predisposition of the patient toward the development of colonic perforation attribute to the regular irrigation of patient’s colostomy site and careful administration of the catheter with a minimum scope of colonic injury. Furthermore, the nurse professional requires monitoring the patterns of swelling and hemorrhage (at the site of colostomy) and events of abdominal pain, myalgia, pyrexia, occult stool, constipation, hematemesis and vomiting that might prove to be the potential indicators of colonic perforation. The appearance of signs of infection at the colostomy site requires consistent tracking to surpass the probability of the development of colonic perforation during the postoperative care. The regular administration of hydration solution necessarily required to ascertain uncomplicated bowel functioning during the course of postoperative intervention. Additionally, the nurse professional must gain the confidence of the patient during the course of postoperative care to ascertain the timely tracking of perforation symptoms and other adverse colonic manifestations for preventively controlling the episodes of colonic perforation during the postoperative-tenure. Discharge Planning Discharge planning for Alma should focus on establishing the pattern of self-care and psychosocial stability while elevating her compliance to the prescribed treatment intervention. The accomplishment of this objective requires close collaboration between nurses, dietitians and social care workers in the context of rehabilitating the patient for efficiently managing her personal requirements while reducing the intensity of clinical manifestations (Smeltzer, Bare, Hinkle, & Cheever, 2009). The discharge planning for the patient must incorporate special instructions for the patient in terms of managing her colostomy status and reporting signs and symptoms of colostomy complications to the medical facility. The patient must also receive dietary recommendations for efficiently managing the gastrointestinal manifestations while complying with the recommended therapeutic regimen. The person-centered and family based approaches require effective implementation during the process of discharge planning in the context of educating the patient and her family members in regularly undertaking irrigation of the colostomy site and cleansing of the surgical wound. Specific instructions regarding the recommended treatment regimen and the contact details of the concerned physician necessarily required in patient’s discharge summary for reporting the adverse clinical manifestations at the time of a medical emergency. The recommendations regarding the requirement of home visits by nurses and physiotherapists warranted in discharge summary to facilitate the extension of desirable healthcare interventions for enhancing the quality of life of the patient as well as wellness outcomes. The expected healthcare outcomes require configuration in discharge summary while establishing the standard of medical care warranted for this cancer patient. The requirement, of undertaking psychosocial interventions by nursing professional need incorporation in patient’s discharge summary in the context of increasing her confidence on the prescribed therapeutic regiment. Exercise and nutritional interventions for challenging the intensification of diabetes, and configuration of weight management strategies required for reducing the predisposition of the patient towards the development of cardiovascular manifestations. The requirement of evaluating the constitutional symptoms, pulmonary manifestations and vital signs (of patient) need incorporation in discharge summary for attaining improvement in patient’s psychology as well as physical health. Conclusion The presented clinical scenario describes the terminal condition of the patient that exhibits the scope of further worsening following the partial removal of her colon and subsequent configuration of colostomy. Patient’s associated co-morbid states further intensify the clinical symptoms that warrant the administration of nursing care strategies for increasing the quality of her life, and associated wellness outcomes. The nurses must administer culturally competent person-centered and palliative interventions while evaluating the personalized requirements of patient and her healthcare challenges across the medical facility. The regular monitoring of patient’s clinical symptoms, administered medication and state of distress necessarily required by the nurse professional in the context of administering psychosocial strategies for reducing the stage of her social stigma across the community environment. The organization of regular training sessions for Alma required in the context of mitigating her self-care deficit and elevating her trust on the recommended therapeutic approaches. The nurse professionals must effectively collaborate with the team of physicians as well as other healthcare members while configuring discharge planning for the cancer patient. Proactive collaboration between patient, nurses and physicians will not only minimize the medication errors, but also reduce treatment gaps requiring effective mitigation for improving the state of health of the affected patient. References Allbee, B. H., Marcucci, L., Garber, J. S., Gross, M., Lambert, S., McCraw, R. J., . . . Slonim, T. A. (2010). Avoiding Common Nursing Errors. Philadelphia: LWW. Christensen, B. L., & Kockro, E. O. (2011). Foundations and Adult Health Nursing (6th ed.). Missouri: Mosby Elsevier. Clark, C. C., & Paraska, K. K. (2014). Health Promotion for Nurses. Burlington: Jones & Bartlett. Coppolino, F. F., Gatta, G., Grezia, G. D., Reginelli, A., Iacobellis, F., Vallone, G., . . . Genovese, E. A. (2013). Gastrointestinal perforation: ultrasonographic diagnosis. Critical Ultrasound, 5(1). doi:10.1186/2036-7902-5-S1-S4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711723/ Donna, D., Ignatavicius, M., & Workman, L. (2016). Medical-Surgical Nursing: Patient-Centered Collaborative Care. Missouri: Elsevier. Geiger, T. M., & Muldoon, R. (2011). Complications Following Colon Rectal Surgery in the Obese Patient. Clinics in Colon and Rectal Surgery, 24(4), 274-282. doi:10.1055/s-0031-1295692. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311495/ Giovannucci, E., Harlan, D. M., Archer, M. C., Bergenstal, R. M., Gapstur, S. M., Habel, L. A., . . . Yee, D. (2010). Diabetes and Cancer: A consensus report. Diabetes Care, 1674–1685. doi:10.2337/dc10-0666. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890380/ Grade, M., Quintel, M., & Ghadimi, B. M. (2011). Standard perioperative management in gastrointestinal surgery. Langenbeck's Archives of Surgery, 591-606. doi:10.1007/s00423-011-0782-y. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101361/ Jonsson, C. A., Stenberg, A., & Frisman, G. H. (2011). The lived experience of the early postoperative period after colorectal cancer surgery. European Journal of Cancer Care, 248-256. doi:10.1111/j.1365-2354.2009.01168.x. http://www.ncbi.nlm.nih.gov/pubmed/20345455 Kwiatt, M., & Kawata, M. (2013). Avoidance and Management of Stomal Complications. Clinics in Colon and Rectal Surgery, 26(2), 112-121. doi:10.1055/s-0033-1348050. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709920/ Liu, L., Herrinton, L. J., Hornbrook, M. C., Wendel, C. S., Grant, M., & Krouse, R. S. (2012). EARLY AND LATE COMPLICATIONS AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMY OR ANASTOMOSIS. Diseases of the Colon & Rectum, 200-212. doi:10.1007/DCR.0b013e3181bdc408. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320086/ Lohsiriwat, V. (2010). Colonoscopic perforation: Incidence, risk factors, management and outcome. World Journal of Gastroenterology, 16(4), 425-430. doi:10.3748/wjg.v16.i4.425. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811793/ Muzyczka, K., Kachaniuk, H., Szadowska-Szlachetka, Z., Charzyńska-Gula, M., Kocka, K., Bartoszek, A., & Celej-Szuster, J. (2013). Selected problems associated with the treatment and care for patients with colostomy – part 1. Contemporary Oncology, 17(2), 134-136. doi:10.5114/wo.2013.34615. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685365/ Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2009). Brunner & Suddarth's Textbook of Medical-surgical Nursing, Volume 1. Philadelphia: LWW. 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