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This is the case of Sarah in which she presented herself to a general practitioner at the time she was suffering from occasional diarrhea and generalized abdominal pain. Hemicolonectomy was performed for her after which her physical condition presented various complications such as abnormal blood pressure, irregular heartbeat, respiratory problem, blood loss dueto surgery, high pain score, and breathing complications. In this essay, the discussion will be done on assessment, potential problems or issues, interventions, and rationales to support the answers for Sarah’s medical condition. Management of the patient's condition will help in giving appropriate care through nursing mechanisms.
Potential problem/ issue
· The blood pressure after the surgery was 90/54
· The respiratory rate was 12 per minute
· Urine output via a Foley IDC: 15-20 mls/hour
<1ml/kg/hour last three hours
· Pain score on a scale from 0-10 was 6
· The patient might experience cardiogenic shock because of low blood pressure. The cardiac output will be diminished. There could also be vasoconstriction in addition to damaging of organs which could happen due to improper stroke volume and deficient circulatory compensation (Vahdatpour, Collins & Goldberg, 2019).
· The patient might develop hypoxia as her respiration rate is lower than normal. The level of oxygen within blood drops which could cause shortness of breath and problems like headache (Cousins, Wark& McDonald, 2016)
· Dehydration could occur in the patient. During surgery, the patient might have lost blood and that could cause less urine output. The person could also develop chronic kidney disease if dehydration is not handled properly (Roncal-Jimenez et al.,
· The pain needs to be eliminated otherwise it will cause the patient a lot of discomforts. It could also slow down the recovery process of the patient after the surgery (Wardhan& Chelly, 2017).
· Support from vasopressors could be given to the patient. While providing the patient with this intervention, it is necessary that monitoring of blood pressure is performed (Vahdatpour, Collins & Goldberg, 2019).
· Acute oxygen therapy could be performed on patient so that oxygen levels would increase in person (Cousins, Wark& McDonald, 2016).
· For recovering patient from dehydration, they could be provided with fluids. It should also be noted that sugary and soft drinks should not be given as they can badly affect the kidney disease because there is the high amount of fructose in them (Roncal-Jimenez et al., 2015).
· Pain could be managed by providing the patient with non-opioid analgesics or we could also give neuraxial and field blocks (Wardhan& Chelly, 2017).
· Vasopressors are given because they can be utilized for creating vasoconstrictions that will in turn increase the cardiac contractibility. These can also increase the blood pressure of the patient so that they don’t have a cardiogenic shock (Vahdatpour, Collins & Goldberg, 2019).
· Acute oxygen therapy could be given to the patient so that the oxygen level would increase in the blood. It would also reduce the signs and symptoms like shortness of breath and headache. It will also show increment in the reading of pulse oximetry (Cousins, Wark& McDonald, 2016).
· Intake of fluids would decrease the progression of kidney disease. It will further provide renal protection and would increase the water content in the body thus eliminating dehydration from the patient (Roncal-Jimenez et al., 2015).
· Analgesic is given to the patient so that the pain could be eliminated and the level of discomfort decreases. Non-opioid analgesics are chosen so that patient does not become dependent on them (Wardhan& Chelly, 2017).
Two clinical complications related to co-morbidities that could arise in 24 hours are:
Assessment and interventions that should be followed by nursing professionals to prevent and identify clinical deterioration are:
The advice that could be given to Sarah for her medication could be that she needs to take her medication on time. She needs to intake simvastatin in the night and captopril in the morning. Captopril will help patient with the renal functioning. It is needed to be provided to patient 1 hour prior to meals. If it is not taken properly then hypotension could also occur in patients which could cause further complications (Marte, Sankar & Cassagnol, 2020). It should also be mentioned that she should come in the hospital for her regular follow-ups and should not miss an appointment with the doctor so that her recovery could be observed by the healthcare professionals. Follow-ups would also help in checking her wound. The patient will also feel safe and reassured (Dahlberg et al., 2018; Nilsson, Gruen & Myles, 2020; Dahlberg, Jaensson& Nilsson, 2019). The nurse should also inform Sarah to consult of a physiotherapist because the pain after surgery can cause a lot of problems in doing daily life activity and could further cause mental problems like anxiety and depression. Physiotherapy has proven that it could eliminate pain and therefore could increase the quality of life (Robinson et al., 2019). The nurse should also suggest Sarah visit a counsellor so that she can deal with various issues like surgery and the pain associated with it, stress of wound cleaning, compliance on drugs, weakness in the lower limbs and education on pain and its management. By providing knowledge on these topics the patient could adjust to the existing situations that have arisen due to surgery. Counsellor in addition to these problems will also help with psychological troubles that are faced by patients such as anxiety, stress or depression. The counsellor will also provide support which is required by the patient and would suggest strategies that could lower the amount of distress faced by the patient. Anxiety and stress management techniques could also be taught to the patient (Raju & Reddy, 2017). The nurse also needs to focus Sarah's attention on keeping her would clean and dry otherwise infections might occur and that could complicate her case(Nuutila et al., 2014). Infections would also slow down the healing process and unwanted scarring could also occur (Nuutila et al., 2014). The nurse also needs to tell Sarah about the severe outcomes of wound infection. The post-operative wound is a chronic wound. The body responds in a manner which consists of the body's inflammatory actions as seen in the case of trauma. If the wound does not heal or systematic or local response fails to start the patient recovery then this could lead to an extensive amount of organ damage. The complicated wound will cause Sarah a lot of trouble and she might need to be hospitalized again so that proper management of the wound could be done. Sarah also needs to maintain her hand hygiene while she touches the wound so that it does not get infected (Nuutila et al., 2014).
As Sarah was a mother of two kids, the nurse should emphasize on spending more time with her kids and her partner after the surgery so that she does not feel affected by a lot of stress and anxiety because of surgery. She could also join some support group which is for cancer patients so that there she can talk about her experience with the surgery. Support groups for a patient involve many functions such as it educates the family members and also the patient about their condition. They also raise awareness about the disease and could also help in raising the funds for the patient who is in need of money. Therefore, joining a support group will overall help Sarah to deal with her situation (Hu A, 2017). Sarah is a chain smoker and for her benefit nurse could suggest her to stop smoking so that her health status could be improved. The nurse could also suggest Sarah meet with a nutritionist so that she could maintain her body structure and could lower down the high level of cholesterols. The nurse could also explain to Sarah that she needs to exercise every day so that she can work on her body and as a result could maintain her health. The nurse could also suggest taking the fruits which consist of fibers and have a high amount of water in them. This could help Sarah to eat healthy things and maintain her diet (Coulman et al., 2020).
In the conclusion, it can be said that nursing priorities in the case of Sarah were to elevate her blood pressure, to normalize her breathing rate, to bring her urine amount at a normal level and also to control her pain. For that nurses need to provide her vasopressors and should give her oxygen therapy in addition to giving her fluids and non-opioid analgesics. The two clinical co-morbidities that were found to arise in 24 hours were respiratory and cardiovascular complications. The condition of Sarah can be improved by following breathing exercises and a high fowler position. Besides this, the nurse could provide her with a treatment plan which involves taking care of the wound, telling her about the importance of her medication. Nurses could also ask her to visit a counsellor and a physiotherapist so that holistic care is performed.
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