Medical-Surgical Nursing - Preventing Deep Vein Thrombosis in Preoperative Patients - Case Study Example

Running Header: Mr. Kumar Your name: Course name: Professors’ name: Date Introduction The study explores the preoperative procedure done on a male patient of 58 years old. The patient’s preoperative data is recorded in regard to nursing assessments of a patient scheduled for surgery. Mr. Kumar is the patient in question. He is scheduled for a colostomy procedure. His medical history is reviewed before the operation. He suffers from morbid obesity, hypertension and hypercholesterolemia. The preoperative procedures are performed on the patient with special attention given to his medical history since it determines the anesthetic that should be administered. Preoperative orders are given to nurses during the change in shifts to ensure the patient’s operation is successful. A daily dose of heparin and TPN is given to Mr. Kumar for the 3 days of preoperative care. The last set of observation is recorded and compared to the initial preoperative data. The heart rate has increased from 90 to 92, temperature from 36.8 oc to 37oc and, the BP has risen from 145/73 to 160/85. The patient complains of pain after the wound drain was inserted in his colon. Actual potential problems of the procedure were assessed and highlighted. The symptoms and patho-physiological aspects associated with the problems highlighted are discussed and appropriate nursing interventions outlined. The study also explores the intended outcomes of nursing intervention and their potential effectiveness. Identify all actual and potential health problems evident from assessing the patient data. Choose two of the actual or potential health problems The problems that Mr. Kumar experience include pain in the right leg, paralytic ileus, Deep Vein Thrombosis (DVT), and, C/O severe nausea. Some of the potential problems that the patient is likely to incur are atelectasis or pneumonia, pulmonary embolism and, pressure ulcer. The patient is likely to face cardiac diseases, fluid overload, poor wound healing, venous ulcer and, stress and anxiety and, risk of infection (Sweeney 2009, p.38). Actual problems during the preoperative period are recorded in the last set of observation after the patient has been draped for the surgical process. There are several signs that indicate the problems. Mr. Kumar complains of pain in his right leg. The data recorded on his blood pressure and heart beat per minute have increased compared to the preoperative data before he was dressed for the operation. Paralytic ileus and DVT show strong symptoms in the patient. The study focuses on paralytic ileus and DVT. The two conditions are actual problems of the patient during the preoperative care. Paralytic ileus is a condition that results from the malfunction of gastrointestinal system. The patient has undergone the anterior bowel resection and the wound drain is inserted in his abdomen as opposed to a colostomy since the procedure is straight and simple according the Mr. Kumar’s surgeon. Paralytic ileus is propelled by the obstruction of the intestinal system when the wound drain is inserted in the colon of the patient. The other problem is DVT which is caused by clinical manifestations (Pruitt & Lawson 2009, p.25). In Mr. Kumar’s case, he was intubated with a 7.5 Endotracheal Tube (ETT), a Nasogastric (NG) tube and, a FG 14 Foley IDC (idiopathic dilated cardiomyopathy) was inserted. A diathermy plate was stuck to his right leg. The preparations described promote DVT thus; it is an actual problem for the patient. The condition forms in the deep veins of lower extremities and the pelvis. The patient complains of pain that nurses confirm increases from 3/10 to 6/10. There are swellings and inflammation in his right leg to confirm DVT. Identify the corresponding signs and symptoms of the health problem, as found in the case scenario The assessment of the problems is done through an efficient diagnosis system and observation of the patient. The patient also communicates their situation for an evaluation of their situation to be done. Mr. Kumar’s last observation shows that he feels pain in his right leg after the preoperative procedures (Lippincott Williams & Wilkins 2002, p.345). The health problems are analysed by reviewing the symptoms and signs that correspond to paralytic ileus and Deep Veins Thrombosis. The conditions have physiological associations that are depicted in the physical body of the patient. Deep Vein Thrombosis affects the low extremities of the lower veins of the legs. The condition usually affects one leg. In the case of Mr. Kumar it is indicated that he experiences pain in his right leg. Paralytic ileus affects the abdominal functions of the body causing discomfort for the patient. There are several symptoms that are noticed when a patient is suffering from paralytic ileus. Some the symptoms include distention where the patient’s abdomen swells abnormally. Abdominal pain and cramping is another symptom that the patient complains about after the wound drain is inserted in their colon. Constipation is another sign of paralytic ileus since the inserted wound drain prevents release of gas. Diarrhea and vomiting signifies the condition in the patient during their preoperative preparations (McCutcheon 2013, p.370). Deep Vein Thrombosis usually affects on leg and in Mr. Kumar’s case his right leg is affected since the last set of observations recorded shows that the patient complained of pain. The symptoms of DVT include pain, swelling and tenderness in the right leg. Other symptoms are continuous aching of the affected area of the leg, warm skin at the affected area and, redness of the back of the leg below the knee. The pain is enhanced when the leg is bent. Identifying these symptoms allows the nurse to take appropriate and effective measures to treat the patient. Explain the patho-physiology associated with the given signs and symptoms Patho-physiology processes associated with the problems identified entail the description of the internal body processes and how they are influenced by the conditions. The symptoms outlined influence the main processes of the body. These processes include the digestion, respiratory, excretory and, nervous (Lewis 2011, p.128). The conditions alter the normal functioning of the body such that the patient begins to experience pain, nausea, constipation and swelling of the affected regions. It is vital for health care givers to pay attention to such condition. The conditions can be prevented or treated depending on the intensity of the preoperative procedures. Physiologic aspect of paralytic ileus entails assessing the abdominal wellness of the patient. Since the patient was not on a diet, they are bound to face difficulty in digestion after the surgery. The preoperative care requires that a nurse assess symptoms such as nausea. Nausea may lead to vomiting and cause the operation wound to open. The nausea is caused by anesthetic drugs given during the preoperative period (Elkin 2007, p.478). DVT association with physiological factors is examined via three aspects of the body system. One of the systems is venous stasis where platelets and thrombin cells aggregate blocking unidirectional blood flow. The process causes continuous aching in muscles (Carlson 2012, p.16). When platelets and thrombin cells merge they interfere with each other’s functions causing pain. The blood is unable to clot and the patient is prone to excessive blood loss. DVT causes hypercoagulability, which causes clotting of blood at the affected area. The hypercoagulability is propelled by the inability of thrombin cells to be activated to prothrombin. The thrombin fails because it is aggregated with platelets. The region becomes reddish and tender. Identify nursing interventions and provide evidence based rationales, which will address the two chosen health problems The role of nurses is to give health care to their patients. In the case of DVT problem, the nurse should ensure that the patient undergoes anticoagulation therapy where heparin and warfarin is administered (Counihan & Favuzza 2014, p.5). Mr. Kumar is given a daily dose of heparin to contain the actual problem. Another nursing intervention in DVT is placing compression stockings on the legs of the patient to prevent further spreading of the condition. Mr. Kumar is prepared with TED stockings to prevent the problem. Nurses that edema is kept at bay by giving patients 100ml of water per day. 2-3 sodium diets are prescribed to control the excessive water in the veins. The infected legs is held above the heart to allow normal blood circulation. The color of the leg is dark compared to the normal leg and the skin integrity is tightened. The nurse advices the patient to avoid clothing that is silky to ensure friction does not occur and cause bruises. Mobilisation of the patient is also an intervention that nurses apply to help patients with DVT. Walking helps ease the blood clot restoring the unidirectional blood flow. For paralytic ileus, the interventions provided by nurses include abdominal assessment where symptoms such nausea are addressed. The nurse can prescribe a diet that allows the patient to overcome the nausea. Medication is also vital where heparin is given continuously for three days and then warfarin is added for the same period an NG tube is also used for nauseated patients. In Mr. Kumar’s case, the Nasogastric tube is inserted to curb the vomiting and distention (Basavanthappa 2003, p.279). Two, the nurse can discourage immediate food ingestion until the ileus is resolved. Mr. Kumar should not be allowed to eat his wife’s food until his paralytic ileus problem is resolved. Chewing gum has been proved as a means to increase gastrointestinal motility thereby, reducing bloating and constipation in patients. The technique is another nursing intervention that can be implemented. Discuss the intended outcomes of the interventions identified The expected result of the described nursing interventions is to ease the pain of patients and restore their normal state of health (Bonner 2004, p.5). DVT interventions are expected to promote unidirectional blood flow and ensure the patient recovers on time. Paralytic ileus interventions aim to redeem the diet of the patient and the gastrointestinal motility. Reflect on the potential effectiveness of these interventions including how you might measure the intended outcomes and what your plan would include if the outcome is not reached. The interventions identified are effective since the patient is engaged in the process. The addition of medicine quickens the recovery of the patient. Assessing the abdominal and neurovascular symptoms of the patient allows the nurse to give appropriate intervention for the cases. The potential effectiveness of the interventions is that the patient’s swelling will cease and their DVT and PI will heal. To measure the effectiveness of the intervention, data prior to the intervention is recorded and compared to data after the intervention. In case the interventions do not give the intended results, the patient is retained in the ward for close monitoring to avoid further complications. Conclusion In conclusion, the preoperative procedures for Mr. Kumar show the significance of data recording. The nurse is able to identify the actual and potential risks through such data. Understanding the symptoms and physiological influence of health problems of a patient allows the nurse to establish proper intervention measurers. References Basavanthappa, B 2003 Medical surgical nursing, New Delhi, Jaypee Brothers Bonner, L 2004, The prevention and treatment of deep vein thrombosis, Nursing Times, Vol.4, no.3, pp.1-10 Carlson, D, S 2012, Preventing deep vein thrombosis in preoperative patients, Nursing center, Vol.6, no.5, pp.14-20 Counihan, T, C & Favuzza J 2014, Fast Track Colorectal Surgery, Nursing center, Vol.28, no.3, pp.1-5 Elkin, M, K 2007, Nursing interventions & clinical skills, St. Louis, MO: Elsevier Mosby Lewis S, L 2011, Medical-Surgical Nursing: Assessment and Management of Clinical Problems, (8th ed) St. Louis, MO: Elsevier Mosby Lippincott Williams & Wilkins 2002, Illustrated manual of nursing practice, Philadelphia, Lippincott Williams & Wilkins McCutcheon, T 2013, The Ileus and Oddities after Colorectal Surgery, Gastroenterology Nursing, Vol.36, no.5, pp.368-375 Pruitt, B & Lawson, R 2009, What you need to know about venous thromboembolism, Nursing, Vol.39, no.4, pp.22-27 Sweeney, W, B 2009, Preoperative Management and Anesthesia, Clinics Colon Rectal Surgery, Vol. 100, no.29, pp.38 Read More