Patient Journey through Preoperative Education, Pre Anesthetic Drugs, Postoperative Pain Management Plan and Checklist, and Surgical Procedure - Case Study Example

The Patient Journey: Name: Institution Affiliation: Part one: Preoperative phase. a) The surgical procedure that the patient received was the Green light laser transurethral resection of the prostate with or without prostatectomy. The procedure is used to relieve patients off urinary symptoms secondary to prostatic enlargement. The working diagnosis for this patient is benign prostatic enlargement. The procedure is less invasive as it uses laser light that vaporizes the enlarged part of the prostate that causes the obstruction of urine flow in men. The operation can be done in a day. There is a telescoping device that is inserted through the penis to get to the bladder. The laser light is then illuminated to the obstructive prostate tissue vaporizing it. This creates a cavity that allows urine to flow once again. The expected outcome of the procedure is that there will be some level of discomfort that the patient will experience within a few weeks when passing urine. In any case the temperature of the patient rises then there is need to add antibiotics into the therapy. These events will occur in the healing phase. In ten to fourteen days, there will be some form of bleeding that is expected. This bleeding is usually from the scab from the healing prostatic tissue. To clear this bleeding, the patient is encouraged to drink a lot of water that will enable him clear some clots and blood residue. The patient is advised not to partake in any form of strenuous activity as this might prolong the healing period. There is restriction from going by his daily activities. For instance, the patient is not allowed to go to work. There should be no driving at any point until maybe after recovery. This procedure tends to have a good outcome as many of the patients regain their normal lives back (Bachmann, 2011). b) The preoperative education that the patient requires is the basic anatomy of the prostate gland and its relations. It is located below the bladder. The urethra passes through it at different stages. The urethra is the tube that the patient passes urine with. The patient needs to understand how the obstructive symptoms come about. With the prostate enlarged, it blocks the bladder. This usually results in the patient having reduced flow of urine. The characteristics of the flow are either difficulty with starting the urine flow or stopping. The nature of symptoms is varied from one patient to another. The problem can be both during the day and night. Patients tend to pass urine frequently than usual. The picture depicts a classical enlargement of the prostate and thus the patient should be able to understand. In explaining to the patient, there is the need for him to understand the procedure and some of the outcomes that he should expect (Murr & Moorhouse, 2014). c) The preoperative checklist will contain a series of lab tests that will indicate the health status of the patient. For starters, a full blood count is pertinent as it will show anemia if present. This is done by checking the level of hemoglobin. Electrolyte levels basically check the vital organs and this include the liver and the kidneys. The electrolyte levels will aid in fluid replacements if needed. It also asses the nature of the excretory system of a patient in case of drugs that will be administered. Vital signs for the patient are pertinent as they indicate the general condition of the patient. The body mass index and weight are essentials as they will enable in assessing the nutritional status. This is supposed to guide in feeding postoperatively. Older patients require thorough evaluation to prevent any complications during surgery. d) The pre anesthetic drugs that were administered include: midazolam, fentanol and timenton. This are expected to reduce the patient’s anxiety in preparation for surgery. They also have a sedative effect and this will aid in hypnotizing the patient during the procedure. The other anesthetic drug that was used is propofol that was given 60ml. Sevoflurane 2.1% was also used. Propofol is a strong sedative hypnotic agent. This is aimed at ensuring the patient is well sedated. The choice of drugs used is dependent on their strength and the amount of time it takes them to act. Depending on the nature of the operation, some patients may be eligible for spinal or general anesthesia. There are a number of factors that determine the drug to be used. Patients’ age is a determinant of the drugs required for surgery. Drug reactions are considered in making the choice of drug. Propofol tends to affect the cardiovascular system and thus checking the blood pressure levels of the patient is vital. Sevoflurane is associated with temperature variations such as fever. It is therefore important for regular monitoring of the patient’s vitals. Anesthesia is the cornerstone of most surgical procedures. There should be proper regulation of the amount of drugs administered. This is to ensure there are no chances of the patient getting overdosed. In administering anesthetic drugs, there should proper estimation of the recovery of the patient. This is to ensure that the patient is able to wake up without any complications. e) The postoperative pain management plan for this patient includes: endone which is given at 2.5mg per hour. There is also substitution with morphine if it is indicated. Pain is usually one of the patient’s main concerns. Pain relief is pertinent. Morphine usually is needed in the case of extreme uncontrollable pain. It is an excellent pain reliever. The drug should be administered in dosages that will not cause problems in patient. The dose of morphine should be carefully regulated. Pain is a common feature in the postoperative period and that is why its management is rewarding for the patient. Part Two: Intraoperative phase. a) The position that the patient was placed was lithotomy. This is where the patient’s thighs are parted and there is proper and clear view of the perineum. The position is essential in ensuring there is enough room for exploration. The prostate gland is located around this region, which makes this position the perfect choice for the procedure. There is ensured efficiency as the incisions will be made appropriately without any interference. b) The aids that were used in supporting the position include: the yellow stirrups, upper limb body straps, gel pads, eye tapes, arm boards and upper body hair bugger to keep the patient warm during the procedure. These aids were important as they ensured the patient was comfortable. They also enhance efficiency when it comes to the procedure. The lower limbs are usually fixed. It is of great importance that they are fixed as this will enable the prevention of any unwanted injuries to the patient. Lithotomy position is an important position when it comes to surgical procedures that involve the perineal or anal areas in general. Most of the aids that were used were basically to stabilize the patient on the surgical table. This way the surgeon tends have easy time. The upper limb body straps are essential as they prevent any form of interference that is likely to come from the upper parts of the body. Arm boards ensure the patient arms have support and prevent any injuries to them (NHS Foundation Trust, 2012). c) The complications that are likely to arise when the patient is placed in lithotomy position include: development of deep venous thrombosis. This can be explained by the elevation of the lower limbs which tends to ensure blood flows downwards due to gravity. This is likely to occur following a longer duration during the surgery. Another complication that has been a problem with the position is the development of compartment syndrome in some patients. This tends to occur with prolonged elevation of the limbs during a procedure. The mechanism of developing compartment syndrome revolves around a buildup of pressure that compromises blood supply to areas with tissues. Tissue function impairment ensues and thus there is compartment syndrome that has developed. The other complications that are likely to arise include the development of pressure sores. These are attributed to the fact that the patient is lying on the back thus he is likely to develop the sores. Dislocation of joints is likely to happen depending on how much are the lower limbs are spread apart. Fractures may develop as this may be due to recklessness in theatre. It is of importance that some of these complications should be prevented from occurring as they are detrimental to the quality of life of a patient. d) During the operation the patient was monitored regularly and this entailed checking the vital signs repeatedly. There was the anesthetic machine, the doctor, nurse, oxygen stats, the ECG machine and intravenous fluids were administered. This kind of regular monitoring of the patient is paramount as it ensures survival of the patient during surgery. It also prevents the development of multiple organ damage that is likely to occur. The anesthetic machine tends to act like a life supporting machine as it balances the anesthesia and normal body functions. The doctor and the nurse anesthetists help in the maintaining of the patient’s vital signs within the recommended ranges. They are also helpful in the resuscitation of the patient after surgery. Oxygen machines ensuring there is adequate supply of the tissues with adequate oxygen to prevent development of hypoxia in the tissues (Kings College hospital, NHS Foundation Trust, 2014). e) Sterile procedures are aimed at minimizing the risk of contamination. The insertion of the catheter and the laryngeal tracheal tube require the maintainace of sterility. Sterility prevents the introduction of harmful microorganisms through instrumentation. The count procedure is pertinent in ensuring all the sequences are followed when handling the patient in theatre. The count procedure is also observed when putting the patient on the theatre table on administration of anesthesia by the anesthetist. The count procedure is essential in keeping in line with the anesthesia time. The counting time enables the anesthetist to determine how long the anesthesia will become effective and when to add the block of time when interruption of anesthesia occurs (Miller & Jocham, 2010). f) The group of specialists that was required in theatre includes: anesthetists doctor, anesthetist nurse, scout, scrub, surgeon and tech. These individuals have different roles in the theatre. The doctor is quite focused in ensuring that the patient is stable. This is achieved by the actual monitoring the patient’s blood pressure readings and recommending drugs. The nurse on the other hand also aids in the regular monitoring of the vital signs. The nurse is helpful in administration of certain drugs. The mixing of certain solutions that are useful in the management is usually work for the nurse. These specialists in the theatre ensure greater support of the patient who is being operated on. The other specialists are supportive as they ensure safety measures in general (Miller & Jocham, 2010). g) In advocating for the patient, there is the actual prevention of bleeding and any forms of injury. By ensuring safety of the patient during the procedure shows the level of advocacy that is great. There should be care to prevent any overdosing of the patient during surgery. Asking for consent is also ensures that the patient has allowed any forms of procedures. Consent is a significant entity before any surgeries are performed. Educating the patient about the entire procedure is important as they need to understand the consequences as a whole. After surgery, the theatre attendants make sure all the equipments that were used during the procedure are accounted for; this is to ensure nothing was left in the patient. Retained items can form a nidus for infection. Part Three: Postoperative phase. a) During the recovery phase the patient was subjected to oxygen therapy of 9 litres. The vital signs were reading a temperature of 36.3 degrees Celsius, blood pressure of 150mmHg/68mmHg and heart rate of 61 beats per minute. There was removal of the laryngotracheal tubes with supplementation of breathing with 6 litres of oxygen therapy. The patient is observed for every ten minutes for the first half hour. The catheter drainages were assessed and any forms of blood clots were removed. The ECG machine is disconnected and the leads tidied. There is also oxygen therapy and the patient is cleaned. The beddings are also tidied. The patient was found to be a wake, alert, breathing spontaneously, comfortable and oriented. The patient seems like he is ready to move back to the ward. This was a proper recovery as the patient regains all the normal functions easily (Dodson & Smith, 2010). b) The most required care by the patient in the recovery room was monitoring of the vital signs. These include: body temperature and blood pressure as this would indicate an imminent problem if they were deranged from the normal. The breathing of the patient is monitored and support is given to the patient before spontaneous breathing is achieved. There is administration of oxygen at a lower rate. The conscious level of the patient is assessed and in this case he seems to have done well as he was breathing spontaneously, alert, comfortable and oriented and being ready to go to the ward. c) Some of the postoperative complications include: bleeding as most patients may experience a mild discomfort when passing urine. The bleeding might be longer in the case of a larger prostate gland. Impotence is a feature that has been noted. After the procedure the patient may develop a little urgency. There is the aspect of prolonged catheterization. This is attributed to the fact that most people tend to have indwelling catheters which may cause difficulty with bladder emptying. Another common complication is retrograde ejaculation. It is where during ejaculation there is no release of sperms. This is problem that most individuals with enlarged prostates experience. This is mostly after surgery and the patient may complain of failure to conceive. The sperms fail to propagate forward and thus there is inadequate fertilization. All these complications change the quality of life of a patient a great deal. Bleeding is dangerous as it could lead to hypovolaemic shock. All these complications are preventable and manageable when proper procedures are done. d) The criteria that the patient had to meet revolved around the vital signs readings and whether the patient was comfortable, oriented, alert and breathing spontaneously. The patient should have recovered properly back to his normal being so as to be discharged e) The information that will be added for the ward staff will be the nature and the outcome of the surgery. The complication that is likely to occur. Vitals sign are significant in order to indicate if there is the needed for fluid resuscitation. The patient’s history and physical examination is of great importance as there will be adequate information for further management in the ward. There are certain restrictions in diet that can be advised to the ward stuff so as not to cause any damage. Generally, resection of the prostate can be a challenging procedure that needs proper care. Lack of this proper care may lead to permanent damages to the patient’s body. The procedure should be done with a lot of care as the anus is in the region. Recklessness might give the patient fecal incontinence due to tampering the anal sphincters causing damage. In terms outcome, this procedure is excellent and it tends to reduce the number of injuries that are usually associated with the radical resection of the prostate. The use of laser light seems economical and less time is spent doing the surgery. There is faster relief of the obstructive urinary symptoms. The anatomy of the prostate gland describes different regions and there various pathologies. For benign prostatic enlargement, it occurs in the midline and that is why it is able to block the bladder. Surgical procedures keep evolving and this has reduced the risk of complications among patients. The outcome of the advanced surgical procedures is good and they seem to have created an alternative. Many patients prefer the advanced surgical modalities. The challenging aspect is the costs that usually accompany these modalities. They are an expensive venture and not every person can afford thus making others at a disadvantage. It is a good modality that can save many patients the many complications that associated with radical methods. References Bachmann, A. (2011). Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms in Men. Oxford University Press,. Dodson, T. F., & Smith, ,. ,. (2010). Medical Management of the Surgical Patient: A Textbook of Perioperative Medicine. Cambridge University Press. Kings College hospital, NHS Foundation Trust. (2014, February). Greenlight Laser Prostatectomy. Ambulatory Care and Local networks , p. 11. Miller, K., & Jocham, ,. D. (2010). Praxis Urologie, Volume 2. Georg Thieme Verlag. Murr, ‎., & Moorhouse, ,. ‎. (2014). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis. NHS Foundation Trust. (2012, February 16). Urology. Green Light Laser Prostatectomy . Read More