Nursing Management: Nursing Care of a Patient with Altered Gasto-intestinal Function - Case Study Example

Students Name: Instructor’s Name: Course Code and Name: Datee of Submission: Item 1: Clinical presentation Findings Nigel has vague memory on the onset of the pain. He has dizziness, fatigue and weariness with vague discomfort in the lower abdomen and unwillingness to eat. He has rapid and deeper breathing. He has a depressed facial expression, decreased motivation and is in a daze. He also has fever and seizures and his abdomen is tender to touch. There is a yellow-green colour on the naso-gastric aspirates. Reasons for the findings The patient has high heartbeat rate due to fever in the body and change in the blood flow due to increased metabolic demands (American Heart Association, 2015). His fear about dying today increases sympathetic stimulation by the sympathetic nerve fibers on the heart and causes adrenaline release by the endocrine system leading to high heartbeat. Dizziness is caused by sweating, nausea, vomiting, having breath shortages and the abdominal pain (Kerber & Baloh, 2011). Being in a daze is caused by the fatigue, some changes in his mood and having low energy. The increased discomfort in the lower abdomen may be due to constipation or indigestion of food due to complications in the body system. The tenderness may be due to blocked or twisted colon (MayoClinic.org, 2013) His unwillingness to it is due to reduced appetite related to the vomiting, anxiety and depression he is facing. Distal obstruction may result to the naso-gastric aspirates being stained with bile and hence the yellow-green colour. Memory loss is due to the occasional pain affecting the brain, reducing attention at certain times (Dallas, 2015). Item 2: Nursing Management: Assessment and monitoring of Nigel’s condition Health history assessment Appetite: Assessing changes in food intolerances, checking for vomiting and changes in appetite. Level of nausea also to be checked Pain: Pain assessment is done using queries on time when the pain occurs, frequencies and whether it is associated with food digestion. Specific places of the abdomen where the pain comes from should also be asked. Lower gastro intestine: The patient should be asked about problems such as haemorrhoids, hernia, flatulence and eructation The patient should also be assessed about previous gastrointestinal disease history such as cancer or inflammatory bowel disease. Baseline observations Tympanic temperature is assessed, the rate of respiration is analysed, rate of heartbeat checked and the blood pressure is also confirmed. Additionaly, saturation of oxygen is also looked into (The Royal Children’s Hospital, Melbourne, 2014). Focussed assessment This is the assessment with details of body systems with specific probles or giving dire concern at the current inspection time. Involves one body system or more.(The Royal Children’s Hospital, Melbourne, 2014). Physical assessment Abdomen: Symmetry of the abdomen should be tested. Pulsating of the aorta at the abdomen should be analyzed. Distention should be checked without touching the abdomen as peristalsis stimulation can occur leading to unreliable results. Auscultation:- Bowel sounds. Stethoscope’s diaphragm portion will be used to check on bowel sounds. The character should be noted whether it is clicking, gurgling or with high pitch. Occurrences per minute should be noted (The Royal Children’s Hospital, Melbourne, 2014). Vascular sounds. The bell of the stethoscope is used to check for blowing sounds and for aortic pulsation hearing. Hyper resonance hearing be assessed incase of gaseous distention. Rectal area. Assessment of the external hemorrhoids and inflammation evidence should be taken. Palpating. The abdomen’s quadrants should be lightly palpated checking for tender and painful parts. Rigidity and tenderness should be noted. Complications Change in bowel patterns. Frequency, amount of bowel and bile staining may increase in the body. This may be due to touching of the patient’s abdomen during the inspection. Altered conscious level may occur leading to problems with historical assessment of the patient in the case of questions. Seizures may occur due to febrile convulsion in case of high temperatures (MayoClinic.org, 2013) Bleeding may occur in the gastro intestinal tract. Abdominal swelling and tenderness may be increased. Other severe complications may be spread of pain to other body parts like the shoulders and the chest and unexplained loss of weight (Kumar & Thompson, 2012) Item 3: Nursing Management: Assessing body temperature It is important to maintain a constant body temperature for maximizing metabolic efficiency and decreasing oxygen use for the patient.Some of the equipment needed in measuring of body temperature include the traditional mercury thermometer, the disposable and the electronic thermometer (Sund-Lavender, 2013) The glass mercury thermometer has a potential of breakage during use, slow response and with a hard-to-read display. Additionally, its vapour is poisonous. On the contrary, it is accurate. The disposable thermometer is more designed for oral temperature examination. It reads adult temperature within a minute but it is liited to one-time use to reduce chances of re-infection or contamination. The electronic thermometer is displayed digitally and has more suitable ares of measuring like the forehead, mouth, armpits and the rectum. It is also easier to read. Methods of measuring body temperature include site of temperature measurement which is divided into oral, axilla (armpit), rectal and forehead temperature reading. Other methods include tympanic thermometry, tactile assessment (Sund-Lavender, 2013) Rectal measurement is freightening to a lethargic patient and also not suitable due to complications due to surgery. Armpit measurement is not accurate because of lack of elavation on the skin on the occurence of a fever. Oral method is ore accurate than skin. Contrary, there is variation in tongue temperature depending on bulb placement. Palpation used in tactile assessent is reliable in predicting fever. Acceptable time frame for body temperature measurement must be one. Accuracy of the easurement may be affected by ingestion of the fluid food and oxygen therapy especially if the rate of flow is rapid (Knies, 2015) For the situation, the best practice will be tympanic measurement as it bases on infrared emissions but would not be affected by environmental or fluid of the operated patient. Also, fluctuations in the core temperature are easily determined due to proximity of the tympanic ebrane to the hypothalamus (Knies, 2015) Item 4: Nursing management – Medication management Opioid infusion using patient controlled analgesic device ensures the patient to administer their own relief in terms of pain. One of the reasons for this is to reduce overdose as the required amount as per the patient’s feeling is used. The patient’s pain is increased at certain times where he needs to press the button for regulation of the acute pain. Satisfaction is increased on the patient when he administers himself opioids (McKesson Health Solution, 2010). Amino glycoside antibiotics are used to inhibit bacterial protein synthesis. They are only used when other antibiotics are less effective or contraindicated. This is because of their side-effects to the kidney or the ear. The aminoglycoside antibiotics are capable of crossing eukaryotic cell membrane killing microorganisms surviving in phagocyte cells (Gade & Mohiuddin, 2014) Dopamine antagonist was used for control of nausea and vomiting. This is done by blocking dopamine receptors prominent in a human’s central nervous system. It is also to prevent adverse events like cardiac arrests in the body (Moawad, 2015). Nursing responsibility for opioid infusion includes regular pulse-checking, checking for dosage change calculation of appropriate drug concentration clearing of the patient controlled analgesic pump upon syringe completion and disposing of the unused portion (Gade & Mohiuddin, 2014). Nursing consideration for amino glycoside use include ensuring sall frequent meals are taken, encourage intake of fluids, checking for renal functioning and function of the cranial nerve for hearing purpose. Responsibility for metoclopramide use include extra pyramidal symptoms assessment, gastro intestinal complaints assessment and ensuring of oral incetion for better absorption (Gade & Mohiuddin, 2014) Monitoring of patient controlled analgesic pump’s use includes programing the pumps correctly and monitoring respiratory response of the patient. Also there needs usage of capnography module everytime the patient controlled analgesic pump is infused. Amino glycosides should be monitored by checking on serum level. Nomogram use to determine dosage of the drug and also monitoring weight level to detrmine dosage. For the metoclopramide pH of the fast stripping continuous cyclic voltammetry should be determined for effective intake. Item 5: Nursing Management: Maintaining fluid and electrolyte balance Nigel is at risk of fluid volume and electrolyte deficit because his hydration is low. The amount of urine is low and this is proportional to hydration level. Vomiting causes low level of fluids in the body.Also, aminoglycosides can produce homeostatic disturbances creating a change in acid-base ratio in the body and abnomrlity of the electrolyte. Fluid imbalance can also be caused by metoclopramide. Maintaining fluid and elecrolyte balance is an important goal in Nigel’s care because it enables good functioning of his heart,nerves and muscles.It is vital in controlling of seizures associated with febrile state(Pharmaceutical Journal, 2015). Respiratory process in his body will be enhanced. Furthermore fluid and electrolyte imbalance may lead to death especially with his vulnerable body system. Monitoring of Nigel’s fluid and electrolyte should be by checking the type of electrolyte supply that is in short supply. Fluid level in the intravenous line should be maintained same to the medicinal intravenous tube. Vomiting should be monitored to know on the level of fluid loss in the body. Monitoring of fever level to check on water loss through sweating can also be a vital way in checking fluid electrolyte imbalance. Metoclopramide intake should also be controlled. Routine monitoring of serum sodium or any cation and osmomality. Incase of higher cation intake, there should be imediate stoppage or reduction of the intake (Pharmaceutical Journal, 2015) Incase of potassium cations problems, there should be preparation of the intake with the food for reduction of gastric irritability. Nigel’s electrolyte and fluid deficit signs include;- tachycardia (his heart rate is a bit faster than normal), his skin elasticity is poor and can not stretch well. He has sunken eyes, loss of consciousness at brief moment and confusion and irritability, disorientation and weakness (Haines, 2013) Item 6: Reflection on process and new learning My placement in caring for Nigel has held a good chance in learning and developing new skills in the nursing profession. First, it created awareness on my part as it made me more assertive and confident in my approach of taking care of the patient. In nursing management, self-awareness is considered a vital component if one has to give an above-the-standard health care especially with acute patients. My motivation, beliefs and recognition of nursing was not altered by any limitation. My goal was to make Nigel heal. The situation made me monitor and strategise y routine well so that enough time would be given in my attendance. I learnt to cope up with irritability of the patient. As I look back, the area that am supposed to develop is patient motivation as treating a hopeless patient may not be very effective. When caring for soeone like Nigel, extreme care should be maintained as a little mistake may be fatal. Role of a nurse, as exhibited in the care is caring for the patient, counselling of the patient, managing interpersonal skills for patients’ lives improvement and most iportantly, hold shifts so as to provide a full-tie care for the patient. I need further developent in personal skills as it ight be vital when am left alone with the patient and also developent in endurance of all conditions eerging from all parts of nursing care. REFERENCES Astle, S.M. (2014) Restoring electrolyte balance. Dallas, M.E. (2015). 5 surprising causes of memory loss. Gade, N.D., Mohiuddin (2014). Journal of microbiology and antimicrobes. Haines, C. (2013). Electrolyte Imbalance. Knies, R.C. (2015). Temperature measurement in acute care. Kumar, N., Thompson, C.C. (2012). Endoscopic management of complications after Gastrointestinal weight loss. Moawad, H. (2015). What is a dopamine and antagonist. Sund-Levander, M. (2013). Assessment of body temperature. British journal of nursing. Read More