Pharmacology Nursing - Post Surgical Aspects of a Patient 18 Hours Following Appendectomy - Case Study Example

Running Head: Pharmacology nursing Student’s name Institution Course Professor Date This essay explores post surgical aspects of a patient 18 hours following appendectomy. It begins with a review of physiological response to surgery and factors that may influence this with a specific concern on Diabetes which is a major comorbidity for her. Then a discussion of the process of collecting wound swab for diagnostic purposes and the role of Intravenous antibiotics for post surgical infection in this patient follows. Other medications that are relevant to her are discussed with their pharmacokinetic interactions is provided. This includes paracetamol, Morphine, Maxalon, Carbamazepine, Nordette and Actrapid Insulin. The steps involved in administering the drugs is given as well as IV therapy including the calculation the drip rate of the IV infusion is discussed. Finally a health teaching plan to assist in understanding the treatment and medications for Misty is given by exploring the drug itself, therapeutic role, expected side effects and need for compliance. The rights of administration of medication and the role of the family in supporting the patient are also reviewed at the end. Surgery is a form of trauma that presents stress to the patient and induces neuroendocrine and immunologic responses that become even more challenging with comorbidities like in this patient with diabetes mellitus. The stress response results in inhibition of insulin release in a normal person and also the stress is associated with peripheral insulin resistance resulting in stress-induced hyperglycemia that occurs in early post operative period. Diabetic patients therefore have a significant stress during the perioperative period with a 50% increased risk of morbidity and mortality compared with non diabetic patients (Brunicardi, Dana, Billa, Dunn, Hunter and Pollock, 2006). They are also prone to complications from infections and also have impaired wound healing. The intact epithelial surface of the skin normally serves to prevent infection in tissues but surgery compromises this barrier. Cellular and humoral immune dysfunction associated with diabetes results in a further increased progression of infection from any contamination that may occur through the surgical wound itself or in other organs (Kumar, 2007). This calls for urgent need in instituting antibiotic therapy and investigations in case of symptoms and signs of infection as those displayed by Misty. Collecting wound swab for microscopy, culture and sensitivity is important to guide targeted antibiotic treatment. This process starts with the gathering of equipment, wash the hands, put on sterile gloves and follow other standard precautions. Bowler, (2001), suggests that the wound be cleaned gently with sterile water or warm normal saline while taking measures avoid touching the wound. Also sterile technique should be observed, use a sterile swab surface or swab container opening to collect the specimen. Use a moistened swab tip and a clear medium in the swab container to make effectiveness of the results better. Starting from the margins of the wound, sample towards the centre, for a period of about 30 seconds to collect adequate wound exudates (Baranoski & Ayello, 2011). Once adequate specimen is collected, store the wound swabs at room temperature and label the specimen with patient’s name, identity number, specimen source, and date and time of collection the container and dispatch to the laboratory as soon as possible. From the specimen, request for microscopic examination, aerobic and anaerobic (if deeper layers involved) cultures and drug sensitivity studies to guide therapy. Surgical intervention to eliminate the source of infection by appendectomy is an integral aspect of source control of infection. However, the role of antibiotic therapy is very crucial following the breach of epithelial barriers during surgery and underling risks in a diabetic patient. Intravenous antibiotics should urgently be instituted in this patient with fever, abdominal pain with nausea and wound site infection all suggestive of infection. Intravenous therapy has the most rapid onset, and also 100% bioavailability due to absent first pass effect and hence higher mean serum antibiotic concentrations resulting in better outcome (Bennett & Brown, 2008). Timentin will provide adequate cover against beta-lactamase–producing isolates of E. coli, K. pneumonia and Bacteroides fragilis group (Katzung, 2006) and hence adequate for this case. The disruption of the integrity of tissues, whether surgical or traumatic, stimulates a series of events that attempt to restore the injured tissue to a normal state. The process of wound healing occurs in an orderly fashion and strikes a fine balance between repair and regeneration of tissue. (Kumar, 2007). This is affected among other factors by the existence of cormobid conditions in the patient. Diabetes mellitus delays wound healing at every stage of the healing process. Insulin has trophic effects on healing tissues whose effect is absent during deficiency states. Hyperglycemia causes osmotic diuresis with subsequent reduced tissue oxygenation and perfusion thus delaying wound healing. Hyperglycemia also inhibits the migratory and phagocytic activity of leukocytes and retard proliferation of fibroblasts and endothelial cells. The complications of neuropathy and the vascular disease (microvascular and macrovascular changes) also contribute to poor healing due to poor perfusion. Therefore, glycemic index correlates with the degree of impaired wound healing (Fauci, 2008). Due to the compromised immune response, patients with diabetes like Misty have a higher risk of surgical site infection which adds insult to the already impaired healing process, slowing down the wound healing. Misty who is 18 hours post appendectomy is likely to benefit from paracetamol treatment for pain and fever; however several considerations have to be made in this case before treatment. The administration of medications is part of the implementation of the nursing process that includes proper preparation of drugs, correct procedure and route for administration, educating the patient on the drug, indications, effects and contraindications (Suzanne C., O'Connell S & Brenda G. B. (2009). It also involves observing for any errors and take appropriate action. According to the Australian Prescription Products Guide, 2007, before treatment counter check name of the drug and dose and confirm that it is the right patient, frequency and duration of therapy as well as the route of administration. Her ability to tolerate oral medications should be assessed to in order to consider other route if not possible such as per rectal. Drug interactions have to be considered in this case given the other medications she is on for other conditions. Paracetamol is metabolized by hepatic microsomal enzymes to sulfate and glucuronide conjugates which are excreted. 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