Introduction to Acute Care Across the Lifespan

Clinical assessment of patients in post-operative care is crucial as it helps in the determination of the efficacy of the interventions and helps in maintaining the well being of the patients Sharda et al., 2019). This essay will be providing a critical discussion on the post-operative care and management needs of a particular case of Sally Brown who has undergone hemicolectomy. This essay will provide an analysis of the required interventions in the first twenty-four hours of post-surgical care. This essay will also identify the potential clinical issues and clinical complications that may arise in the case of the patient and produce a succinct discharge plan for the patient.

Acute Care Across the Lifespan - Part A

Post-Surgery Care Plan

Assessment

Potential problems

Interventions

Rationale

Respiratory health

Shallow breaths with RR of 12 Breaths per minute and oxygen saturation of spO2 of 95% on 2L oxygen supplementation, signals the risk of respiratory depression.

Regular oxygen supplementation (Posthuma et al., 2019)

Breathing exercises (Posthuma et al., 2019)

Monitoring of respiratory rate and oxygen saturation levels regularly (Nelson et al., 2016)

The goal of this intervention should be to normalize the respiratory rate and oxygen saturation levels of the patient without oxygen support.

Low respiratory rate is common after a major surgery due to the effects of sedation. However, it is critical to maintain the normal oxygen saturation levels in post-operative care through oxygen supplementation and to maintain the healthy respiratory rate in the body (Posthuma et al., 2019). Breathing exercises will help in lung expansion and further normalization of the oxygen saturation levels (Nelson et al., 2016)

Pain assessment

Pain score of 6/10

Analgesic administration in postoperative care in collaboration with the clinicians (Rawal, 2016)

Positioning to minimize pain (Mitra et al., 2018)

Patient observation (Mitra et al., 2018)

The goal of these interventions should be to minimize pain and bring it to the scale of 3 or below.

Severe pain can result in major discomfort in the patient and can consequently affect the vitals, Post-surgical management of the pain should be done through the administration of the analgesics (Rawal, 2016). Analgesics help in reducing the pain by targeting the pain receptors of the body and provide instant comfort to the patient by limiting pain sensation (Mutra et al., 2018).

Positioning is also done to ensure the well being of the patient through minimization of the pain (Mitra et al., 2018).

Observation of the health condition of the patient must be done regularly with pain assessments to determine the effect of medication, record improvements, and analyses further application of interventions for the clinical management of the patient (Rawal, 2016).

Blood pressure and heart rate assessment

Low, 90/54mmHg with the pulse of 116 beats per minute (irregular)

Pain management (Xu et al., 2020)

Observations (Sharda et al., 2019).

The goal of these interventions should be to ensure normalization of the patient vitals.

To regularize the heart rate and the pulse of the patient, it is crucial to managing the pain of the patient, excessive pain can affect the heart rate (Rudolphi, 2019).

The low blood pressure of the patient can be associated with the effects of sedation and must be monitored regularly to ensure the recovery from the surgery and wellbeing (Xu et al., 2020).

Urinalysis

Urine output less than 1ml/kg/hour

Liquid diet (Spencer et al., 2020)

Observation (Spencer et al., 2020)

The goal of these interventions should be to ensure fluid balance management in the patient.

The urine output of the patient is below the normal range and must be maintained through the provision of the fluid diet. Poor urine output is common in patients post-surgery. Provision of a liquid diet will help in maintaining the fluid balance of the body (Spencer et al., 2020).

Acute Care Across the Lifespan - Part B

Comorbidities of The Patient

Comorbidities in a patient can have a significant impact on the successful completion of the process of surgery and the impacts anesthesia administration (Dabu-Bondoc & Shelly, 2015). In the given case study, the patient suffers from a range of pre-existing medical conditions that can impact the overall recovery and well-being after the surgical procedure. Sally is a 66-year-old retired teacher and has a medical history of myocardial infarction, hypertension, and hypercholesterolemia. The patient is also an occasional drinker and a chronic smoker with a consumption of about 15 cigarettes a day. The patient is also overweight with a weight of 92 Kgs with a BMI of over 33. Presence of these comorbid conditions significantly impacts the rate of recovery in the patient post-surgery (Spruce, 2015). Administration of general anesthesia is done in conjunction with the care needs of these patients in terms where the preoperative evaluation of the blood pressure and hypertension. During anesthesia, the goals are to prevent extreme swings in the blood pressure of the patient (Dabu-Bondoc & Shelly, 2015).

The effects of sedation in the post-operative condition are therefore regularly monitored to ensure stabilization of the patient. The hemodynamic stability is also maintained before the administration of anesthesia and also in the post-operative condition (Wenli et al., 2016). The patients are at risk of cardiogenic shock and therefore, the heart rate of the patient, blood pressure, and the myocardial contractibility are regularly assessed to determine the well being of the patient in response to sedative treatment (Dabu-Bondoc & Shelly, 2015). Since the patient is also a chronic smoker, the efficacy of the respiratory system in the patient can be deduced to be compromised. Increased complications are associated with the patients in postoperative conditions with the administration of general anesthesia (Nergusa et al., 2016). The primary concern with chronic smokers and patients with respiratory problems is the airway responsiveness in the post-operative conditions (Spruce, 2015). Obstructive sleep apnea of the patient must also be taken into consideration for post-operative care as it can impact the respiration and further worsen the risk of respiratory distress (Dabu-Bondoc & Shelly, 2015). 

Potential Clinical Complications

The major potential problem that is associated with the case of Sally Brown is the high risk of respiratory distress and collapse (Spruce, 2015). Anesthesia administration can cause bronchial hyperreactivity in some patients and the post-operative care, this can result in significant bronchospasms. Another major concern with the patients is post-operative pre-intubation following the general anesthesia (Wernli et al., 2016). These risks include risk of development of pneumonia, systematic inflammatory response, and airway constriction. Since the patient already possesses cardiac problems with myocardial infarction and hypertension, there is a need to manage her health condition to prevent further exacerbation through a drastic change in the blood pressure and the management of the heart rate (Nergusa et al., 2016).

The significant complication that may also arise is the risk of sepsis post-surgery. The vitals of the patient must be kept in check and the wound care regime must be followed critically. In the current scenario, the wound of the patient has minimal ooze and therefore, it is crucial to care for the wound and maintain sanitary conditions to prevent infections. There is a risk of complication regarding the increase of pain as well. The patient has a current pain score of 6/10 that requires management and if not treated immediately can further accelerate and worsen the health of the patient. The risk of pain will also affect the vitals and thereby may pose a risk to the cardiovascular health of the patient as well (Dabu-Bondoc & Shelly, 2015). The patient has been advised to undergo adjuvant chemotherapy, therefore the recurrence of the tumour is also of critical consideration for the wellbeing of the patient.

Nursing Assessment and Interventions

Postoperative nursing care is provided to the patients after surgery with interventions developed that focus on the health history and the surgical procedure of the patient (Guo & Fan, 2016). Nursing assessment is crucial in post-operative care as it focuses on the recovery from surgery, normalization of the vitals of the patient and overall management and care (Rudolphi, 2016). The primary nursing intervention in the provided case scenario should be to help in the normalization of patient vitals. The respiratory rate of the patient is low. The assessment of the respiratory health of the patient must be done using spirometer and assessment of respiratory rate (Posthuma et al., 2019). The oxygen saturation levels of the patient must be normalized without the need for oxygen supplementation (Broens et al., 2020). Therefore, it is required that patient is assisted for breathing exercise by the nurses. Breathing exercises will help in lung expansion and thus help in the restoration of breathing. As the oxygen supplementation is provided, it should be ensured that the patient is also positioned to minimize the respiratory distress through diaphragm movement to provide space for lung expansion and ease the process of breathing (Nelson et al., 2016).

To regularize the urine output and the fluid balance of the patient, the only liquid diet should be permitted to the patient. The fluid balance of the patient can be tested using urinalysis. The fluid balance of the patient must be managed to compensate for the excessive blood loss during the surgery and also to maintain the overall wellbeing of the patient (Gürsoy et al., 2016). Electrolyte balance will also be maintained through fluid diets and thus prevent nutrition and fluid-related complications in the patient. The heart rate and the blood pressure of the patient must be monitored regularly (Idvall & Ehrenberg, 2016). Pain management is required to regulate the pulse rate of the patient. In collaboration and prescription by the clinician, an analgesic can be administered to the patient for pain management (Rawal, 2016).

Further, it is also required that pain is assessed regularly to determine the efficacy and well being of the patient. The neurological assessment should also be done as the effect of sedation fades out from the patient (Mitra et al., 2018). A GCS assessment should also be done to check the alertness and cognitive abilities of the patient post sedative surgery (Broens et al., 2020). It is suggested that the ABCDE assessment is followed for the initial assessment of the patient in the post-operative stage for a holistic approach. It is also crucial to frequently check the surgical site for the wound dressings (Rudophi, 2016).

Acute Care Across the Lifespan - Part C

Discharge planning is defined as the development of a personalized plan for a patient who is leaving the hospital after recovery (Kang et al., 2020). The purpose of this plan is to ensure the provision of suitable instructions to minimize the development of secondary complexities and limit hospital readmissions. Post-surgical and operative care for the patient, Sally Brown and discharge planning is aimed at complete recovery from the surgery and normalization of the patient vitals (Olson & Heise, 2016). The discharge planning of the patient is inclusive of the identification of the care needs of the patient after they leave the hospital and ensure a safe transition from the hospital to home care through a systematic approach. In the provided case study, the patient should be discharged from the clinical setting after complete recovery from the surgery and overall management of the health condition with stabilized vitals (Jones et al., 2017). The pain should have been minimized and the movement of the patient should be restored before discharge. It is suggested that post-discharge the chores and work of the patient is assisted in the course of recovery. The patient should be advised to not lift any object for at least six weeks after the surgery.

The patient is also advised to not drive and is expected to return to the regular functioning and work after six weeks of the surgery (Jones et al., 2017). Diarrhea and loose stools are of common occurrence after the surgery and hence, Sally must be informed about the same. These can last for a couple of weeks and thus proper patient education should be provided (Kang et al., 2020). Regular assessment after the surgery is required to assess the incidence of bowel infections or any other secondary complications. The patient is also advised to manage diet and add solid foods slowly to resume back to the regular diet (Sari & Dahlia, 2020). Initially, Sally should be given a low fibre diet that may be slowly increased in the food plans (Jones et al., 2017). The patient is also advised to include nutritional supplements in the diet with intake of the pain medications as prescribed by the doctor. Hydration is crucial and thus the patient is advised to include adequate hydration in the diet with regular intake of water. The wound and incision care requires critical care and thus, it is advised that post-discharge, the patient gently pat dries the wound and maintains sanitation to prevent infection.

Wound and incision care must be maintained and in the case of ooze or suspicion of infection, immediate care must be ensured by a professional visit. A follow-up appointment must be ensured within fifteen days of discharge or prior in case of any experienced complications (Sari & Dahlia, 2020). The patient is also suggested to seek immediate medical aid if the patient possesses fever that persists after discharge. A call for medical aid should also be made if diarrhea in the patient persists for more than three consecutive days after the discharge. Nausea and vomiting should be phased out by the time of discharge. However, in case of nausea or the occurrence of similar complications, assistance from professional aid should be ensured (Pandit et al., 2018). If the pain is poorly managed and not regularized by the used of prescribed medication, it is suggested that medical aid is sought.

Any signs of drainage or redness around the wound must be immediately recorded. It is suggested that the patient monitors the stool after the surgery and cases of red or dark stool should be informed to the clinician. The patient is a chronic smoker and is suggested to enrol in a cessation program to assist the process of recovery and help in the improvement of the health. It is also advised that Sally limits the consumption of alcohol and makes a positive change towards an active lifestyle (Sari & Dahlia, 2020). The patient possesses multiple comorbidities and thus it is advised that clinical help is sought in any form of the observed anomaly. Medication adherence should be ensured by the patient to prevent further complications in the health condition and to assist in the process of recovery (Pandit et al., 2018). Due to pain and limited movement along with elderly age, the patient is also at high risk of falls and thus, it is suggested that patient is assisted constantly for movement and is provided to support to prevent the risk of falls and further complications (Pandit et al., 2018).

Conclusion on Acute Care Across the Lifespan

This document provides a detailed case analysis of a sixty-six-year-old patient, Sally Brown who has undergone a hemicolectomy surgery. This document identifies the potential complications in the post-operative care of the patient and also recognizes the suitable interventions for the same using an evidence-based approach. Further, this paper also underlines the complications that are associated with the outlined comorbidities of the patient and the administration of general anesthesia. In this analysis, potential risks and health issues, as well as nursing assessment and suitable interventions, have also been identified. A discharge plan for the patient has also been developed to ensure complete recovery and transfer of care from the clinical to the home setting.

References for Acute Care Across the Lifespan

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