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.
Adetona, O., Reinhardt, T. E., Domitrovich, J., Broyles, G., Adetona, A. M., Kleinman, M. T., ... &Naeher, L. P. (2016). Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhalation Toxicology, 28(3), 95-139.https://doi.org/10.3109/08958378.2016.1145771
Alman, B. L., Pfister, G., Hao, H., Stowell, J., Hu, X., Liu, Y., & Strickland, M. J. (2016). The association of wildfire smoke with respiratory and cardiovascular emergency department visits in Colorado in 2012: A case-crossover study. Environmental Health, 15(1), 64.https://link.springer.com/article/10.1186/s12940-016-0146-8
Bird, Y., & Staines-Orozco, H. (2016). Pulmonary effects of active smoking and secondhand smoke exposure among adolescent students in Juárez, Mexico. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1459.https://dx.doi.org/10.2147%2FCOPD.S102999
Burns, A., Strawbridge, J. D., Clancy, L., & Doyle, F. (2017). Exploring smoking, mental health, and smoking-related disease in a nationally representative sample of older adults in Ireland–A retrospective secondary analysis. Journal of Psychosomatic Research, 98, 78-86.https://doi.org/10.1016/j.jpsychores.2017.05.005
Coulman, K. D., MacKichan, F., Blazeby, J. M., Donovan, J. L., & Owen-Smith, A. (2020). Patients’ experiences of life after bariatric surgery and follow-up care: A qualitative study. BMJ Open, 10(2).
Cousins, J. L., Wark, P. A., & McDonald, V. M. (2016). Acute oxygen therapy: A review of prescribing and delivery practices. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1067–1075. https://doi.org/10.2147/COPD.S103607
D’amato, G., Vitale, C., De Martino, A., Viegi, G., Lanza, M., Molino, A., ... &D’amato, M. (2015). Effects on asthma and respiratory allergy of Climate change and air pollution. Multidisciplinary Respiratory Medicine, 10(1), 1-8.https://mrmjournal.biomedcentral.com/articles/10.1186/s40248-015-0036-x
Dahlberg, K., Jaensson, M., & Nilsson, U. (2019). “Let the patient decide”–Person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: Secondary analysis of a randomized controlled trial. International Journal of Surgery, 61, 33-37.
Dahlberg, K., Jaensson, M., Nilsson, U., Eriksson, M., &Odencrants, S. (2018). Holding it together-patients' perspectives on postoperative recovery when using an e-assessed follow-up: Qualitative study. JMIR mHealth and uHealth, 6(5), e10387. https://doi.org/10.2196/10387
El-Zaatari, Z. M., Chami, H. A., &Zaatari, G. S. (2015). Health effects associated with waterpipe smoking. Tobacco Control, 24(Suppl 1), i31-i43.https://tobaccocontrol.bmj.com/content/24/Suppl_1/i31.short
Galán, I., Simón, L., Flores, V., Ortiz, C., Fernández-Cuenca, R., Linares, C., ... & Pastor-Barriuso, R. (2015). Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues. BMJ Open, 5(12).https://bmjopen.bmj.com/content/5/12/e008892.short
Hu A. (2017). Reflections: The value of patient support groups. Otolaryngology-Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(4), 587–588. https://doi.org/10.1177/0194599817697030
Jayes, L., Haslam, P. L., Gratziou, C. G., Powell, P., Britton, J., Vardavas, C., ... & Fletcher, M. (2016). SmokeHaz: systematic reviews and meta-analyses of the effects of smoking on respiratory health. Chest, 150(1), 164-179.https://doi.org/10.1016/j.chest.2016.03.060
Liu, J. C., Mickley, L. J., Sulprizio, M. P., Yue, X., Peng, R. D., Dominici, F., & Bell, M. L. (2016). Future respiratory hospital admissions from wildfire smoke under climate change in the Western US. Environmental Research Letters, 11(12), 124018.https://iopscience.iop.org/article/10.1088/1748-9326/11/12/124018/meta
Marte, F., Sankar, P., & Cassagnol, M. (2020). Captopril. StatPearls. StatPearls Publishing: United States of America
Masiero, M., Riva, S., Oliveri, S., Fioretti, C., &Pravettoni, G. (2018). Optimistic bias in young adults for cancer, cardiovascular and respiratory diseases: A pilot study on smokers and drinkers. Journal of Health Psychology, 23(5), 645-656.https://doi.org/10.1177%2F1359105316667796
Melani, A. S., Sestini, P., &Rottoli, P. (2018). Home oxygen therapy: Re-thinking the role of devices. Expert Review of Clinical Pharmacology, 11(3), 279-289.
Nilsson, U., Gruen, R., & Myles, P. S. (2020). Postoperative recovery: The importance of the team. Anaesthesia, 75, e158-e164.
Nuutila, K., Katayama, S., Vuola, J., &Kankuri, E. (2014). Human wound-healing research: Issues and perspectives for studies using wide-scale analytic platforms. Advances in Wound Care, 3(3), 264–271. https://doi.org/10.1089/wound.2013.0502.
Raju, B., & Reddy, K. (2017). Are counseling services necessary for the surgical patients and their family members during hospitalization? Journal of Neurosciences in Rural Practice, 8(1), 114–117. https://doi.org/10.4103/0976-3147.193551
Robinson, A., McIntosh, J., Peberdy, H., Wishart, D., Brown, G., Pope, H., & Kumar, S. (2019). The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review. PloS One, 14(12), e0226227.
Roncal-Jimenez, C., Lanaspa, M. A., Jensen, T., Sanchez-Lozada, L. G., & Johnson, R. J. (2015). Mechanisms by which dehydration may lead to chronic kidney disease. Annals of Nutrition and Metabolism, 66(3), 10-13.
Steel, L., Ho, F. K., Sillars, A., Petermann-Rocha, F., Li, H., Lyall, D. M., ... & Pell, J. P. (2019). Dose-response associations of cardiorespiratory fitness with all-cause mortality and incidence and mortality of cancer and cardiovascular and respiratory diseases: the UK Biobank cohort study. British Journal of Sports Medicine, 53(21), 1371-1378.https://bjsm.bmj.com/content/53/21/1371.abstract
Vahdatpour, C., Collins, D., & Goldberg, S. (2019). Cardiogenic shock. Journal of the American Heart Association, 8(8), e011991.
Wardhan, R., & Chelly, J. (2017). Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy. F1000Research, 6, 2065. https://doi.org/10.12688/f1000research.12286.1
Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help
Proofreading and Editing$9.00Per Page
Consultation with Expert$35.00Per Hour
Live Session 1-on-1$40.00Per 30 min.
Doing your Assignment with our resources is simple, take Expert assistance to ensure HD Grades. Here you Go....
Get Flat 10% Discount Upto A$50 on all Assignment Orders:
Get 20% OFF upto A$40 on your First Assignment order.
Get 500 Words Free on your Assignment: