Nursing Assessments Post Operatively
Nursing Considerations of IVT
Case management after post-operation is a crucial practice as it requires rendering harmonize care to the patient to reduce health care issues such as infection. Therefore, post-operative care is an essential part of the Registered nurse job (Silva, Martins & Jardim, 2015). Further, it is a prime duty of RN to give holistic care to the ill person. Every surgery requires a different protocol for the nurse to follow as each case is different. The registered nurse must use appropriate rationales and critical thinking while applying the protocol according to the patient history and the kind of surgery they have undergone (Silva, Martins & Jardmin, 2015).
A registered nurse in the post-operative unit must be aware of any complications. Moreover, the registered nurse should be ready to intervene, if the conditions get worse (Silva, Martins & Jardmin, 2015). The purpose of this report is to discuss the assessment of a post-operative patient, Oliver Thompson who has just undergone an emergency appendectomy. Followed by a thorough discussion of consideration the registered nurse should make while giving IV therapy.
Appendectomy is a surgical process in which an inflamed appendix is removed by either the traditional open style or the new version of laparoscopic surgery (DeVellis, 2016). In both processes, the nurses need to follow the same protocol. Nevertheless, in a traditional appendectomy procedure, the wound is much bigger and has more chances of infection followed by appendix rupture. Once Mr Oliver is out of the operation theatre and under the supervision of the nurse, the first and foremost step of the Nurse should be to check his vital signs and temperature. As, the registered
nurse should have goals of checking vital signs, pain management, NBM status and assessing and cleaning the surgical site to formulate a customized care plan. The vital signs must be compared with the policy and guidelines depending on the patient’s history (Mahama & Noinnoni, 2019). Closely monitoring of the vital signs will help in analyzing the recovery of the patient from anesthesia(Mahama & Noinnoni, 2019). The patient must come out of the anesthesia. However, in the present case, the patient's vital signs are showing good recovery. Further, his blood reports are lying within the normal range. But, he is having symptoms of slight tachycardia therefore, his vitals must be followed closely to evaluate if there will be any changes (Koutoukidis, Stainton, & Hughson, 2017).
The normal range heart rate per minute for an elder person is within range of 60-100, whereas Mr Oliver's vital signs show 101 beats per minute that is approximately within the range only. Mr Oliver is afebrile; a registered nurse must keep track of the fever of the patient in post-operative settings as a fever indicates the presence of an infection or sepsis, abscess or peritonitis. Therefore, fever is an alarming sign (Koutoukidis, Stainton & Hughson, 2017). A registered nurse must consider the pain assessment postoperatively and provide the care according to the result of the assessment. The nurse should follow the proper pain assessment tool to evaluate the level of pain. The pain assessment tool consists of questions and aids to provide pain scale, which is ranges from 1-10. Pain assessment tool helps the health care workers to understand the level of discomfort the patient is feeling. Further, pain evaluation aids to compare the level of pain the patient is experiencing each day to ensure that whether the medication is working effectively or not (Xavier et al., 2018).
After surgery, the patient is experiencing a pain that is 7/10 in scale. In the present case also, the pain assessment tool will help the registered nurse to consider the condition of the patient (Xavier et al., 2018). The increase and decrease in the severity of pain will indicate the development of an abscess and or sepsis (Xavier et al., 2018). After assessing pain, the nurse can reduce the level of pain by putting Mr Oliver in a semi-Fowlers position (Chanif & Prastika, 2019). A supine position causes the lower abdomen tension, which creates pain. Moreover, the semi-Fowler’s position eases that pain by localizing the inflammation (Chanif & Prastika, 2019). A suitable medication can also be given to the patient to reduce the pain (Xavier et al., 2018). However, morphine must not be given to Mr Oliver. As the patient is allergic to morphine and reported rash development after taking morphine. Asking the patient about their pain is also a way of checking the level of consciousness, a change in this level indicates that the patient is in shock. In the current case, the patient is fully oriented concerning time and place.
Postoperatively, the registered nurse should also be concern about patient diet, as after surgery most of the patient does not feel to eat or drink something and after. that becomes agitated because of hunger or thirst and ask the nurse for something by mouth (Chon, Ma & Mun-Price, 2017). However, it is one of the assessment requirements of the nurse to keep an NMB status to avoid the discomfort of early intestinal peristalsis, vomiting or gastric irritation (Chon, Ma & Mun-Price, 2017). As MR Oliver is nothing by mouth, the registered nurse must make sure of his eating and drinking status.
A registered nurse must check the incision and clean it precisely so that the chances for infections are also reduced. After the postoperative phase approximately 3 to 5 days, it is recommended to use a non-touch method for removing and changing the dressing. Moreover, dressing changing frequency should be minimizing to favours adequate wound healing. In the present case, Mr Oliver has some blood in his incision that must be catered to immediately because if it's left uncleaned it may cause an infection or abscess (Silva, Martins & Jardim, 2015). To ease the pain in the incision, the nurse may also put ice on it so that nerves are desensitized (Xavier et al., 2018).
Intravenous therapy must also be efficiently administered and managed by a registered nurse. The registered nurse must make sure that the PIVS insertion site is perfect and not causing any pain, swelling and/or patency these sites are high risk for pressure injuries (Ben et al, 2017). The nurse must also appreciate that no oozing of any sort of blood or mucus follows the insertion (Lime et al., 2018). If any of these signs occur the insertion must be changed at once. The oozing must be cleaned properly, and a new IV line must be inserted
The splint tapes must also be checked so that they are not too tight or too loose. (Lim et al., 2018). Tight splint tapes can cause irritation and loose cannot secure the cannula. Mr Oliver already has an IV cannula inserted and is prescribed normal saline which is administered intermittently. Before commencing new normal saline, the nurse must flush the cannula, with a 10 ml syringe and 0.9% sodium chloride to reduce the chances of infection (Keogh et al., 2016). The nurse must make sure that all the medication must be administered intravenously and orally. The chart must be checked, and the accurate dosage must be given to avoid medication error. Mr Thompson is allergic to morphine which must be kept in mind and alternative opioids must be given to him (Rickard et al, 2018). Antibiotics of broad-spectrum must be administered to the patient too and all the dosage and routs must be exact. While planning the care plan and rendering holistic care to the patient, it is essential to follow evidence-based practice.
It can be concluded that the nurse in the post-operative unit is under immense pressure to track the condition of the patient and one wrong move, or negligence may cost the patient. Many times due to the hectic schedule, there are incidents when the slightest overlooking of the vital signs cost the patient. During recovery day after post-op day, nurses must keep their observation skills at the highest to avoid documentation and medication error. Relying on the machine only for documentation will cause problems. Therefore, the Registered nurse posting in the post-operative care setting must closely observe the patients for any abnormalities or change in the condition that may be monitored and later addressed.
When the patient comes in the ward after surgery, the nurse must go through the history of the patient and the surgical notes of the patient. After that, the correct protocol as per the provided by the hospital must be followed without missing any step. Checking for vital signs frequently, managing the pain through the correct dosage of the medications and non-medicated activities such as using ice patch at the incision site must be done thoroughly. The IV insertion must also be checked for any kind of infection or swelling, and while administering a new IV fluid line must be flushed to avoid infection or blockage.
I- Hi, I am Malkit Singh working as a registered nurse in (mention place), and I am handing over Mr Oliver Thompson who is 60 years old male patient shifted to ward after surgery.
S- Mr Oliver Thompson was admitted to the ward with a confirmed ruptured appendix preoperatively, and an emergency open appendicectomy surgical operation was done. Mr Thompson has an intravenous cannula (IVC) in-situ, on his right cubital fossa, which is connected to Intravenous Normal Saline, which runs at the rate of 120mls/hour and his incisional site soaked with blood.
O- He is afebrile and is tachycardic with a pulse rate of 101 beats per minute (bpm). His blood pressure is normal, which is 124/82mmhg. Further, his respiratory rate is 19 breaths per minute. His current pain score is 7/10.
B- Mr Thompson is an asthma patient, and his asthma is in control. He has an allergy to morphine.
A- The agreed plan is that his IV fluid is finished and need to replace it with new 500 MLS of normal saline prescribed by the doctor.
R- I need you to review the patient (mention time and nurse name).
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