Nursing Care in Altered Gastrointestinal Function - Term Paper Example

Nursing Care in Altered Gastrointestinal Function Student’s Name Institutional Affiliation Nursing Care in Altered Gastrointestinal Function Clinical Presentation Patients who have undergone a surgical procedure need to be monitored and evaluated for any surgical complications that accompany some of the procedures (Vonlanthen et al., 2011). The costs of complications can be significant if they are not managed in time as asserted by Vonlanthen et al., (2011). Therefore, assessment, monitoring and evaluation of the patient’s condition is a critical element of nursing care of a post-surgical patient such as Nigel. During the assessment, symptoms that would be observed would be those visible on first approaching the patient. The patient is in pain so he would appear restless and even exhibit grimace due to the discomfort that the patient is experiencing. It is possible that a post-surgical complication might be the aetiology of the abdominal pain and the patient's discomfort (Ma et al., 2012). Among the possible complications include an anastomotic leak, postsurgical infection or bacteraemia and paralytic ileus (Bisanz et al., 2008; Kirchhoff, Clavien & Hahnloser, 2010). On observing the chest and abdomen, movements would be rapid due to tachypnoea. This may be a result of volume depletion occasioned by fluid loss and perioperative haemorrhage, or septicaemia occurring postoperatively (Kirchhoff, Clavien & Hahnloser, 2010). The abdomen may be distended if the peritoneum is full of accumulated leaked fluid (Kirschhoff, Clavien & Hahnloser, 2010). Purulence of the surgical site might be observed especially if there is an underlying postsurgical infection (Loftus et al., 2009). The patient's conjunctiva may appear pale, or his palms may be paper white if he has lost significant quantities of blood through haemorrhage (Sahin, Bilir & Ayaz, 2014). His skin might feel cold especially in the peripheral with a reduction in the capillary refill that could both be occasioned by peri and postoperative fluid and blood loss (Sahin, Bilir & Ayaz, 2014). The clinical presentation of Nigel as would be observed by the nurse would be important in giving the nurse a general picture of the patient and enable the prioritization of assessment of the patient. Assessment and Monitoring Assessment, monitoring and documentation of the relevant patient parameters is an instrumental part of caring for a patient such as Nigel. Vitals’ assessment shall include the pulse rate, respiratory rhythm, rate and depth, oxygen saturation, temperature, systolic blood pressure, and his degree of consciousness (Liddle, 2013). However, the respiratory readings might be affected by the opioid analgesic prescribed as patient controlled analgesia since opioids are known to cause some inhibition of the respiratory centre (Jarzyna et al., 2011). The readings obtained from assessment of the vital parameters shall be compared with previous reading obtained for the same patient and an evaluation of the patient's recovery or deterioration can then be made based on these findings and when a comparison is made to the normal standard vital readings. The aetiology behind the tachypnoea shall be examined, and management measures shall be instituted. Septicaemia occurring postoperatively and volume depletion may lead to a septic and hypovolemic shock respectively that commonly presents with tachypnoea (Shoemaker & Beez, 2010). Palpation of the radial pulse may also show a high rate due to the sympathetic response to the hypovolemia (Sahin, Bilir & Ayaz, 2014). Intravenous fluids or even blood transfusion may be necessary if the patient's haemoglobin is deemed low, and antibiotic treatment shall be required for the management of septicaemia (Bonano, 2012). Temperature, blood pressure and pulse rate resulting from hypovolemia and infection would be normalised when the two aetiologies are managed. Pain assessment shall inform the nurse concerning the comfort levels of the patient and in addition to an assessment of Nigel’s consciousness, shall enable an appropriate adjustment of the patient' opioid analgesia and avert a possible side effect of respiratory depression associated with opioids (Grissinger, 2008; Jarzyna, 2011). Drainage from the wound is a significant indicator of how the wound is healing as poor wound healing accompanied by accumulation of pus at the surgical site is indicative of surgical site infection (Loftus et al., 2009). Treatment of the infection using appropriate antibiotics may be necessary in such case (Liddle, 2013). Apart from surgical site infection, paralytic ileus is also a possible post-colectomy complication (Bisanz et al., 2008). Assessment findings such as a dearth of gastrointestinal movements or bowel sounds on auscultation may raise the suspicion of paralytic ileus as a complication. Assessment of the intravenous site for patency would be necessary while ascertaining the appropriateness of the indicated fluids and the rate of their run. The volumes of fluids running through the intravenous site would form part of the fluid input that together with the output, shall be monitored with appropriate documentation in the fluid balance chart (Huang, 2009). Input fluid monitoring is significant in managing hypovolemia while output through the urinary catheter would be critical in assessing urinary output which is synonymous with kidney function and salient in averting acute renal failure. Assessing Body Temperature Assessment of body temperature is a significant procedure that aids in augmenting diagnostic findings such as infection. In addition, the cyclic variation in temperature is characteristic of some infections hence the need for a reliable and accurate temperature assessment method (Barnason et al., 2011). Invasive temperature assessment methods include rectal, oesophageal, nasopharyngeal and pulmonary temperature assessment, though accurate and precise in assessing core temperatures, are not as practical as non-invasive methods such as temporal artery, aural membrane, axillary, and oral temperature measurement (Sund-Levander & Grodzinsky, 2013; Barnason et al., 2011). The accuracy of a given non-invasive method of temperature assessment is ascertained by comparing the readings obtained by such a method to those obtained using an invasive method such as pulmonary temperature (Barnason et al., 2011). If the former’s reading varies from the latter’s by at least 0.50C, the non-invasive method may be considered inaccurate or imprecise (Barnason et al., 2011). The appropriate timeframe for body temperature assessment is partly based on the site or method of temperature assessment and the instrument used. For instance, Rubia-Rubia, Arias, Sierra and Aguirre-Jaime (2011) assert that gallium in glass thermometer exhibit high accuracy and reliability when temperature assessment is done for 12 minutes. However, the reliability and accuracy is much lower if the assessment is done for only 5 minutes. On the contrary is the infra-red thermometer that Rubia-Rubia et al., (2011) assert that it can give precise and accurate tympanic temperature readings within a minute. The different temperature assessment methods come with their merits and demerits with the most affected been the non-invasive methods. The axillary temperature gives lower readings compared to core temperature, is affected by underarm sweat, device placement, ambient temperature, and rapid variations in temperatures (Sund-Levander & Grodzinsky, 2013). These demerits are shared by temporal temperature readings. Tympanic temperature findings are dependent on correct probe placement and absence of otitis while the oral route temperature readings are impacted by intake of cold or hot meals, chewing gum, smoking, salivation, probe placement and open mouth breathing (Mazerolle et al., 2011). Therefore among the non-invasive methods of temperature assessment, tympanic temperature should be recommended but invasive methods such as the pulmonary artery temperature remains the most accurate indicator of core body temperature. Medication Management Nigel has been prescribed an opioid analgesic to relieve the visceral pain resulting from the surgical trauma. Opioids have good analgesic properties in such cases due to their activity on brain opioid receptors dampening the reception of pain from visceral organs and the wounded sites (Jarzyna, 2011). When administered as a patient-controlled analgesia, the patient is allowed control over the relief of pain by pressing a button to administer a specific dose of the opioid. Depending on the pain assessment findings through an appropriate pain scale, the dose of the opioid to be released on each press of a button is specified thus limiting the chances of over-administration of the narcotic (Jarzyna, 2011; Craft, 2010). Therefore, over-sedation risk that could be associated with large bolus doses of opioids administered by a nurse is greatly reduced while enhancing patient’s comfort (Craft, 2010). Nigel has been prescribed an aminoglycoside antibiotic because of its good bactericidal activity against gram-negative bacteria associated with the colon flora capable of causing post-surgical infections (Fry, 2013). In addition, its gram-positive activity enables it to treat or act prophylactically against bacteria causing surgical site infections. On the contrary, metoclopramide has been prescribed to control vomiting and nausea that the patient is experiencing that could be linked to the opioid analgesics and post-anaesthesia (Pierre & Whelan, 2013). The nurse's responsibility under medication management entails ensuring that the medication prescribed is administered "to the right patient, at the right time, at an" appropriate dose and route of administration with the necessary documentation in a medication chart (Elliot & Lie, 2010). Response to medication shall be monitored through assessing decline in nausea and vomiting for metoclopramide, improved wound healing for the antibiotic, and comfortable pain levels for the opioid analgesic. Nigel's sedation status or consciousness level shall be monitored to avoid a possible respiratory depression as a side-effect of opioid analgesic and enable appropriate alteration of opioid’s dosage (Jaryzna, 2011 & Elliot & Lie, 2013). Fluid and Electrolyte Balance Maintenance Maintenance of fluid and electrolyte within their acceptable normal limits is instrumental in caring for most post-surgical patients such as Nigel. The risk for fluid and electrolyte deficits is high among such patients due to various factors. These include nausea and vomiting possibly associated with the opioids or post-anaesthesia that diminish both the electrolyte and fluid fractions of the patient (Kirchhoff, Clavien & Hahnloser, 2010). In addition, nasogastric tube suction is accompanied by losses of fluid and electrolytes worsening the patient’s risk of the imbalances. Also, injury during the peri-operative stage of the colectomy may have harmed blood vessels resulting in substantial losses of blood consequently precipitating the imbalance in fluids and electrolytes (Kirchhoff, Clavien & Hahnloser, 2010). The smaller, resected colon may not absorb as much water as would a non-resected normal colon, thus limiting the retained body water content and precipitating fluid deficits. The fever that Nigel exhibits predisposes him to significant fluid losses through perspiration worsening any underlying fluid deficit (Liddle, 2013). Lastly, the fact that the patient is not taking any oral foods or fluids, fluid deficit is a possibility especially if intravenous fluid replacement does not compensate sufficiently for the decreased oral intake (Kirchhoff, Clavien & Hahnloser, 2010). The clinical repercussions of fluid and electrolyte deficits such as acute kidney failure and hypovolemic shock can be life-threatening to the patient and worsen his prognosis (Sahin, Bilir & Ayaz, 2014). Therefore, it is paramount that fluid intake and output be routinely monitored and documented appropriately to inform the identification of symptoms of dehydration or hypovolemia and implement timely management measures. Among the reliable techniques for monitoring and documentation of Nigel’s fluid and electrolyte balance is through incorporation of a fluid balance chart. The chart consists of the different types and volumes of fluid administered or consumed by the patient and the time that they were administered in addition to the volume of fluid excreted or eliminated by the patient through various pathways (Liddle, 2013). Among the documented content include volumes and types of IV fluids administered, estimated volumes of fluids lost through nausea and vomiting, wound drainage volume and its colour, nasogastric tube drainage, stoma colour and urine output (Liddle, 2013). The patient’s blood pressure shall also be salient in monitoring the patient’s fluid volume status. Deficiencies in body fluids shall be signified by parameters such as low blood pressure, diminished skin capillary refill and diminished urinary output (Liddle, 2013). Reflection Through this assignment entailing the care of Nigel, I have learnt that assessment and monitoring of post-surgical patients is useful in the identification of potential complications and allow timely initiation of management measures to improve the patient’s prognosis. I have also appreciated the need to be knowledgeable about the nursing management of post-surgical patients, and, specifically, understanding the range of possible complications and their presentation associated with specific procedures such as colectomy. For instance, since the risk of infection is high after colectomy, I should be ready to manage it comprehensively among other possible complications. Registered nurses, among other responsibilities, are tasked with the assessment, monitoring and providing nursing care for post-colectomy patients. Routine monitoring of vitals, assessment and monitoring of patient’s comfort, stoma appearance, fluid status of the patient, wound healing and the general patient picture forms the scope of registered nurse responsibilities for such a patient. After working on this assignment, I notice that caring for a post-colectomy patient requires more knowledge than that which may be gained from lecture halls. 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