• Internal Code :
  • Subject Code : NRSG258
  • University : Australian Catholic University
  • Subject Name : Nursing

Case Study: Edward (Ted) Williams

1. The Roper-Logan-Tierney model utilized in nursing is focused over the patient preference and it is considered to understand all the patient-related aspect to provide the proper treatment. The model of living has the five components like activity of living, lifespan, dependence, factors related to the activity of living and individuality in living that affect patient directly (Holland & Jenkins, 2019). The case is about an 82-year-old man Edward who is administered to the hospitals for bowel resection and he is 4 days post-operative. The Edward now as a temporary colostomy and his history indicates previously he has colposcopy and biopsy which reveal the presence of malignant mass.

The medical history of Edward indicates the presence of multiple disorder which include type II diabetes mellitus, heart failure, gout and obesity. He is a widower lives alone retirement village after his wife died and his two children are settled with their family in town. On the fourth day of post-operative after his regular morning routine, he vomited and feels nauseous after taking medication. He complained about the abdominal pain that is about 5/10 over pain scale that increases on palpitation. Edward vitals reveals SpO2 94%, temp 38, respiratory rate 26 and hear rate 98 with blood pressure 135/85. The nursing assessment reveals that he has inspiratory coarse crackle and moist cough and has no output after the surgery that lead to sluggish bowel sound with no flatus. The tension of the Edward family may increase due to his deteriorating condition that directly increases the spirituality as they pray for the better health status of Edward.

2. One of the key attribute to the health professional practise considered to be the clinical reasoning cycle that helps to improve the patient assessment. The clinical reasoning cycle includes eight steps and stage three indicates process the information collected from the patient. The fourth stage includes identification of the issue related to information collected after assessment (Gummesson et al., 2018).

Small bowel obstruction is considered to be one of the most common post-surgical adhesive complications that directly lead to an increase in the discomfort of the patient (Asuzu et al., 2018). Bowel obstruction is considered to be an abdominal emergency that directly leads to decrease bowel movement which causes decrease output of the individual. Different clinical features are associated with the prevalence of bowel obstruction that includes the history of trauma or surgery, persistent abdominal pain, decreased heart rate, bowel sound and decrease output.

The bowel obstruction directly increases the complication of the individual as he/she will be unable to pass stool or flatus. The bowel obstruction leads to blockage of the bowel which directly alters the normal body functioning and increases complication The complete or partial blockage of the bowel directly increases the risk for multiple disorders like Cohn’s, colon cancer or hernia (Mu et al., 2018). The symptoms of Edward indicate he is facing postoperative complication that leads to bowel obstruction which is predicted by no output after surgery, bowel sound and no flatus.

Chronic abdominal pain is one of the most commonly encountered complain by the health care professionals and it can occur due to organic or functional disorder. The abdominal pain proceeds when the entrapment of cutaneous branches of sensory nerves occurs that supply blood to the abdominal wall. The abdominal pain can be of two type localized that occur due to the A-delta nociceptors and other is visceral pain that initiates due to C-type nociceptors. Many factors can lead to chronic abdominal pain which includes disrupted fat, mechanical abnormality and history of surgery.

The chronic abdominal pain directly leads to increase the discomfort of the patient thus require urgent attention. The abdominal pain is associated with multiple complications that directly increase the need for a proper diagnosis to understand the issue behind the abdominal pain (Kamboj et al. 2019). The past medical history of the Edward indicates surgery that is the reason for the abdominal pain which is increasing his discomfort. There is a need to immediately provide accurate intervention to reduce discomfort fo Edward

The airflow limitation that is increasing discomfort of the patient indicates the presence of chronic obstructive pulmonary disease. It occurs due to the combination of the two condition which includes chronic bronchitis with emphysema that lead to inflammation of the airways with destruction to the alveoli walls. The different symptoms that are associated with the disease include increasing breathlessness, persistent chesty cough, expiration prolongs and chest tightness. The different risk factors that are associated with the prevalence of chronic obstructive pulmonary disease include individual factor, genetic factor and environmental factors. The different factor directly reduces the functional capacity of the lungs by forming free radical, inactivating anti-protease and decrease prevention capacity.

The next step includes the lung inflammation that leads to high proteolysis destruction which causes emphysema and repeated injury to bronchia which causes bronchitis that increase the complication. The chronic obstructive pulmonary disease remains untreated it can lead to acute exacerbation which directly increases the chances of lung inflammation (Boucherat et al., 2016). The Edward sign indicates increased respiratory rate, difficulty in breathing and moist cough that provide a sign for the presence of chronic obstructive pulmonary disease.

3. The fifth stage of the clinical reasoning cycle implies to identify the appropriate nursing care intervention that can be used to increase the comfort of the patient (Gummesson et al., 2018).

The first interventions that can be used to decrease the postoperative abdominal pain of the Edward include acupuncture method. The acupuncture method directly utilizes the needle to activate the abdominal pain point which directly reduces the post-operative pain. The acupuncture technique is considered to be one of the best non-pharmacological techniques that help to reduce pain and decrease the requirement of the analgesics. The acupuncture technique is considered to be safe as it does not have any side effect over the patient and it has high efficacy. The nurse can help the patient to understand the need of the treatment and they are expected to assist the therapist during the treatment to increase the comfort of the patient which increases the participation in the treatment (Wu et al. 2016).

The diet intervention is useful to reduce complication associated with the bowel obstruction as it directly increases the burden over the digestive tract. The diet intervention includes managing the nutrition intake in the patient suffering from bowel obstruction as it directly decreases the nutritional absorption that causes negative consequences. The diet plan will include omega-3 fatty acid as it as the anti-inflammatory property that directly helps the individual to deal with bowel obstruction. The next aspect of the diet includes fibres because they improve the growth of the favourable gut microorganism that helps in the conversion of the dietary component. The individual will be asked to avoid the food component that can provoke their symptoms and reintroduce vegetable, fruits and whole-grain in the diet to improve the nutritional intake (Nguyen et al. 2016).

The third interventions that reduce the chronic obstructive pulmonary disease complication include self-care technique. The self-care technique for the chronic obstructive pulmonary patient includes a different method that directly decreases the dependency of the patient over others. The first aspect is the educational method that helps to increase the understating of the patient regarding disease and possible consequences. The next aspect of the intervention includes exercise education that improves the understanding of the patient regarding different exercise that can directly improve the breathing capacity of the individual. the next aspect includes home telemonitoring for patients that help to stay connected with the patient and health care professional can assist them if they face any issue (Murphy et al. 2017).

The behavioural intervention is considered to be one of the methods that can reduce the loneliness of the individual and help to form a social circle which increase the confidence of the individual. The first aspect of the intervention includes skill development intervention which helps the individual to improve a different skill that can help them to improve mental well beings like gardening, computer programs, sports and voluntary participation. The second aspect of the intervention includes animal interaction as they are considered to reduce and spread happiness. The animal interaction acts as a coping mechanism for the loneliness and improves the mental wellbeing of the individual (Gardiner et al. 2015).

The lifestyle intervention will help to improve the metabolic process of the individual and increase the physical wellbeing. The lifestyle intervention will help to reduce the burden created by the different disorder. The lifestyle intervention will include daily slow walking which helps to increase the endurance and improve the breathing of the individual. The yoga is another aspect of the individual that can help to improve the body metabolism which directly has a positive impact over physical wellbeing of the individual. The last aspect is including meditation in daily routine to maintain the mental wellbeing and help to improve the physical wellbeing of the individual (Juang et al. 2017).

4. The first drugs that can be prescribed to Edward include thiazolidinediones that help to reduce complication associated type 2 diabetes mellitus. It considered being the anti-diabetic drug that directly works to maintain the blood glucose level and reduce the complication. The pharmacodynamics associated with the drug start by activating the PPARs that are nuclear receptor. The activation of the receptor leads to modification of the gene that improves insulin sensitivity. The side effects that are associated with the drug include headache, low blood sugar level, oedema, muscle pain and irritation. The nurses are expecting to monitor the blood glucose level of the patient on routine bases to have a track that can be used to understand the effect of medicine over the individual (Nanjan et al. 2018).

Allopurinol is considered to be the urate-lowering medication that helps to treat gout and decrease the complication. It is in involved to lower down the uric acid amount the blood that is involved to increase the complication of the individual by suffering from gout. The pharmacodynamics of enzyme includes inhibition of the enzyme associated with the conversion of the hypoxanthine to xanthine that converts into uric acid. The alternate pathways of the medicine increase the reutilization of molecules like hypoxanthine and xanthine that indirectly cause the feedback inhibition of the de novo purine synthesis.

The allopurinol is metabolized by the liver to get a metabolite that is oxypurinol that cause the inhibition. The side effect associated with the drug includes increased blood pressure, weight gain, insomnia, nervousness and mood swing. The nurses are expected to monitor the patient before administrating the drug for the presence of any allergy and after the drug administration, continuous monitoring is required (Qurie et al., 2019). These medication can help Edward to reduce complication associated diabetes and gout that will directly improve his physical wellbeing.

References

Asuzu, D., Pei, K. Y., & Davis, K. A. (2018). A simple predictor of post-operative complications after open surgical adhesiolysis for small bowel obstruction. The American Journal of Surgery, 216(1), 67–72. DOI:10.1016/j.amjsurg.2018.02.031

Boucherat, O., Morissette, M. C., Provencher, S., Bonnet, S., & Maltais, F. (2016). Bridging lung development with chronic obstructive pulmonary disease. Relevance of developmental pathways in chronic obstructive pulmonary disease pathogenesis. American Journal of Respiratory and Critical Care Medicine, 193(4), 362–375. DOI:10.1164/rccm.201508-1518pp

Gardiner, C., Geldenhuys, G., & Gott, M. (2016). Interventions to reduce social isolation and loneliness among older people: an integrative review. Health & Social Care in the Community, 26(2), 147–157. DOI:10.1111/hsc.12367

Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews, 23(1), 29–34. DOI:10.1080/10833196.2018.1450327

Holland, K & Jenkins, J. (2019). Applying the Roper-Logan-Tierney Model in Practice. Ashland, Ohio: Evolve Publishing.

Juang, C., Knight, B. G., Carlson, M., Schepens Niemiec, S. L., Vigen, C., & Clark, F. (2017). Understanding the mechanisms of change in a lifestyle intervention for older adults. The Gerontologist, 58(2), 353–361. DOI:10.1093/geront/gnw152

Kamboj, A.K., Hoversten, P. & Oxentenko, A. S. (2019). Chronic abdominal wall pain: a common yet overlooked etiology of chronic abdominal pain. Mayo Foundation for Medical Education and Research, 94(1), 139-144.

Mu, J.-F., Wang, Q., Wang, S.-D., Wang, C., Song, J.-X., Jiang, J., & Cao, X.-Y. (2018). Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction. Medicine, 97(34), 1-6. DOI:10.1097/md.0000000000012011

Murphy, L. A., Harrington, P., Taylor, S. J., Teljeur, C., Smith, S. M., Pinnock, H., & Ryan, M. (2017). Clinical-effectiveness of self-management interventions in chronic obstructive pulmonary disease: An overview of reviews. Chronic Respiratory Disease, 14(3), 276–288. DOI:10.1177/1479972316687208

Nanjan, M. J., Mohammed, M., Prashantha Kumar, B. R., & Chandrasekar, M. J. N. (2018). Thiazolidinediones as antidiabetic agents: A critical review. Bioorganic Chemistry, 77, 548–567. DOI:10.1016/j.bioorg.2018.02.009

Nguyen, D.L., Limketkai, B., Medici, V. (2016). Nutritional strategies in the management of adult patients with inflammatory bowel disease: dietary considerations from active disease to disease remission. Current Gastroenterology Reports 18(55), 1-7. https://doi-org.libraryproxy.griffith.edu.au/10.1007/s11894-016-0527-8

Qurie, A., Bansal, P. & Goyal, A. (2019). Allopurinol. Treasure Island, United Kingdom: StatPearls Publishing.

Wu, M.-S., Chen, K.-H., Chen, I.-F., Huang, S. K., Tzeng, P.-C., Yeh, M.-L. & Chen, C. (2016). The efficacy of acupuncture in postoperative pain management: a systematic review and meta-analysis. PLOS ONE, 11(3), 1-12. DOI:10.1371/journal.pone.0150367

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