Acute Care Across the Lifespan

Introduction to Sarah Brown Post-Operative Care Case Study

Post-operative care is considered to be the most crucial part as the patient is more susceptible to acquire different issue that can lead to deteriorated health status (Zakhary et al., 2017). The case study is about Sarah and she went for the open right hemicolectomy as she was diagnosed with the adenocarcinoma in the ascending colon. There is a great deviation in the vitals after the surgery that needs urgent attention to improve the health of the patient. The essay is going to analyse the case study to provide the care plan for the patient.

Assessment

Potential problems / issues

Interventions

Rationales

· The post-operative assessment reveals that the pain score of the patient is 6 out of 10 that need urgent attention

The uncontrolled acute postoperative pain can lead to the conversion to chronic pain.

Pulmonary and cardiac complication also occur due to persistent severe pain

Can lead to neuropathic pain

The self-reported pain reporting is important to understand the pain from a patient perspective like location, radiating and intensity (Kang & Demiris, 2018).

Cryotherapy is one of the important intervention to improve postoperative pain with no side effects

The self-reported pain reporting by the patient is important to address the specific radiating and intensity of the pain important for patient-centric care (Kang & Demiris, 2018).

Cryotherapy is important to reduce the blood flow, edema, haemorrhage and decrease enzymatic activity (Chumkam et al., 2019)

· The postoperative patient assessment reveals the decrease blood pressure that leads to increase complication for the patient

The weakness and dizziness that hamper the routine of the patient.

Persistent low blood pressure lead to damage to or brain

Blurry vision that can lead to fall which leads to injury

Fluid resuscitation is important to address the decreased blood pressure of the patient

Dietary intervention is important to improve the salt intake to improve blood pressure.

 Fluid resuscitation is important to improve the electrolyte balance for the patient that assists to improve the blood pressure (Smith et al., 2014).

The dietary intervention will help to improve the sodium intake that is necessary to uplift the blood pressure to decrease further complication (Kawamura et al., 2018). 

 

Assessment

Potential problems

Interventions

Rationales

Respiratory discomfort is also observed in the patient after the surgery which is due to the low respiratory rate that is 12 breath per min

 Decreased blood oxygen level

Respiratory acidosis

Bradypnea state which increases breathing issue

 Deep breathing exercise is important to improve the breathing issue faced by the patient

Yoga also has some different exercise that can be included in daily routine to improve breathing

Deep breathing excuse is directly related to the decreased chances of the pulmonary complication. It is one of the best methods to improve postoperative respiratory complication (Ünver et al., 2018).

Yoga is important to improve the overall wellbeing of the patient and it also helps to improve the breathing pattern of the patient (Yamamoto-Morimoto et al., 2019)

Decreased urine output is also indicating in the patient post-operative assessment that needs to be addressed. 

 Sodium and fluid retention can lead to cardiovascular complication

Urinary tract infection is also evident

 Fluid intake therapy is important to improve the urine output

Medication is another aspect that can help to improve urine output

 Fluid intake therapy includes monitored intake of the fluid that will help to improve the urine output (Klein et al., 2018)

One of the medications that can be utilized to improve the urine output is the furosemide that will help to reduce the complication (Vincent et al., 2020).

Analyzing and Discussing the Case to Identify Potential Clinical Issues

 Different complications can due to the general anesthesia and thus after the surgery patient should be properly assessed to decrease chances of any complication. The cardiovascular complication that arises as the complication of the general anesthesia includes hypotension and hypertension. The potential consequences of these events lead to the myocardial ischemia, cardiac arrest, bleeding, brain injury and stroke (Merry & Mitchell, 2018). The patient medical history of hypertension and the blood pressure of the patient before the surgery is 140/95 that can increase the complication of the patient due to the general anesthesia. One of the studies presented by Yancey R. (2018) discussed that minor deviation in the blood pressure in the patient before the surgery needs to be accurately managed before the surgery to avoid general anesthesia. The general anesthesia can lead to cardiac complication which can be a heart attack, heart failure and cardiac arrhythmia. 

Smoking and alcohol are considered to be one of the potential risk factors for the prognosis of the cardiovascular disorder that is a detrimental effect over the individual wellbeing. The nicotine is the major component in the cigarette and it an alkaloid that is an addictive drug. The consumption of the nicotine has a direct impact over the vascular function as its result in the pathological alteration of the endothelial function that causes misbalance in vasodilation or vasoconstriction. Smoking is also associated with a high level of total cholesterol in the serum that leads to cardiovascular complication. Atherosclerosis also results from the smoking as it leads to the thickening and hardening of the artery which increases cardiac issue (Keto et al., 2016). The patient social history indicates that she smokes 15 cigarettes a day that leads to increase nicotine consumption which has a detrimental effect over patient health. There were also significant for the alcohol use from the patient social history but the amount is minimal that also add the negative impact over the body functioning of the patient.

One of the complications associated with the general anesthesia includes myocardial ischemia that occurs as a result of the cardiovascular issue. The cardiovascular complications of the patient are common after the post-operative period thus nurses are expected to properly assist the patient to reduce chances of complication. The different assessment should be conducted to understand the current state of the patient (Schiff, et al., 2014). The patient has a medical history of myocardial ischemia that increases her risk to encounter the cardiovascular complication in post0oiperative period due to the medical history. The increased risk for cardiac dysfunction is evident in the patient having a medical history of the cardiac issue thus proper assessment is required.

The obstructive sleep apnoea is the condition that arises due to the reduced in the airflow that leads to the collapse of the upper airways during sleep. The different risk factor that led to the obstructive sleep apnoea condition includes obesity, alcohol use and smoking. Different complications are associated with the obstructive sleep apnoea that includes congestive heart failure, pulmonary hypertension and stroke. There are increased complications that are associated with the post-operative condition with the patient having obstructive sleep apnea that includes pneumonia, myocardial infarction, pulmonary embolism or cardiac arrhythmias (Osman et al., 2018). The smoking, obesity and alcohol use of the patient leads to the prevalence of the obstructive sleep apnea which can increase issue in the post0oiprative condition of the patient. The current states of the patient need to be accurately assessed to identify the presence of any issue.

One of the complications that can occur within 24 hours of the surgery is the myocardial ischemia as the patient history indicates the presence of the many risk factors that can increase during the postoperative period. The article presented by Heusch, (2016) indicate that myocardial ischemia arises when the oxygen demand of the cardiac tissue increases the supply of the oxygen. The myocardial ischemia condition can increase complication for the patient as lead to heart failure or arrhythmia. 

Pulmonary embolism is another complication that can occur to the patient that can lead to an increase in respiratory complication for the patient. The medical history of myocardial ischemia and the presence of cancer increases the risk for the prevalence of the pulmonary embolism. One of the studies presented by Morici, (2014) discussed that pulmonary embolism is the condition that arises due to the blockage of the pulmonary artery by a thrombus. One of the major complications of that lead to the prevalence of the pulmonary embolism is the major operation that includes hip, knee or abdominal surgery. Other risk factor includes obesity, cardiovascular disorder and cancer. The patient encountered with the pulmonary embolism has to face the different respiratory issue that leads to deteriorated health of the patient which increased risk for disorders like an obstructive shock. 

Assessment: Electrocardiogram will be utilized to identify the presence of the myocardial ischemia so that proper intervention can be done. The study presented by Sattaz & Chhabra, (2020) discussed that Electrocardiogram is utilized to evaluate the electric activity of the heart which is important to identify any abnormality in the function of the heart.

Intervention: Beta-blockers can be used to improve the heart functioning that is important to reduce the impact of the myocardial ischemia and it also helps to reduce further compilation. The article presented Steg & De Silva, (2014) discussed that Beta-blockers are important to decrease the heart workload which eventually improves the functioning. The nurse can assist the patient to understand and follow the routine of the medication to decrease the chances of further complication associated with the myocardial ischemia. 

Assessment: The ventilation-perfusion scan is preferred to diagnosis the pulmonary embolism by utilizing the radioactive material that is important for the analysis of the airflow and blood flow in the lungs. The study presented by Righini et al. (2017) discussed that ventilation-perfusion scan utilizes the injection of the tracer in the vein in your arm. This trace is utilized to maps the blood flow and compare it with the airflow in the lungs which is important to identify the blood clots. 

Intervention:  The use of the anticoagulant is the first-line treatment for the pulmonary embolism and one of the medications is rivaroxaban that can be used to improve the health of the patient. The study presented by Agnelli & Becattini, (2015) discussed that the anticoagulant treatment of the pulmonary embolism follows three phases that slowly reduces the blood clot which improves the airways. This intervention will help to decrease the breathing issue that occurs due to the obstruction which eventually improves the patient health.

Discharge Planning

Discharge planning is a process that involved every individual surrounding the patient to participate and put their input to improve the self-efficacy of the patient. The discharge plan should be framed in such a way that collects all the relevant and important concerning patient care. There are different types of discharge plan but planned one is considered to be best as they included all the necessary information for the patient and the other relevant information concerning the health status. There are three stages of the discharge plan that should be followed to improve the patient self-sufficiency to manage health status (Nordmark et al., 2016). Different aspects need to be included in the discharge plan of Sarah so that she can be able to reduce complication associated with surgery and improve lifestyle. Different aspects need to be included in the discharge plan of Sarah like education about medication, surgical site care, life modification changes. This information will help to use the holistic approach in the discharge plan to address all the necessary information.

The pre-discharge planning includes collecting all the relevant information concerning the patient health status, medication, treatment procedure and assessment. The nurses are expected to use teamwork skills to collect all the different information so that proper documentation can be done to reduce the chance of any omission that can occur due to lack of information (Coffey et al., 2019). The information that needs to be collected in the Sarah discharge plan includes information concerning the surgery, post-operative intervention and current health status. This information will help to accurately document all the relevant information that will be helpful for future assistance.

The discharge planning that includes conveying all the necessary pieces of information of the patient which are important for the management of the health issue after the discharge. The discharge planning includes conveying about health data, personal data, environment data and family role. The health data includes the conveying the patient about the current health status and further complication that can occur due to the risk factor. It also includes information concerning the medication routine, importance and side effects. The personal data includes their action that needs to be improved to reduce the chances of complication related to health (Patel & Bechmann, 2020). 

Sarah will be educated concerning her medication so that she can be able to maintain the daily routine and have understanding concerning the potential side effects. The educational session will also include information concerning the surgical site care to reduce the chances of surgical site infection. The studies presented by Tartari et al. (2017) indicate that patient engagement in the surgical site care is important to decrease the chances of surgical site infection after the discharge which can delay the treatment. The surgical site care includes proper dressing, hand hygiene and wound site assessment to identify the presence of infection.

The lifestyle modification session will also be included in the Sarah discharge plan that will include physical activity and dietary intervention information. The obesity and cardiac tissue of the patient increase the need for lifestyle modification for the patient. According to Wadden et al. (2012), lifestyle modification is important to improve the sedentary lifestyle by increasing physical; activity. The lifestyle modification also helps to improve the calories consumption and expenditure which will help to improve the body mass index

The post-discharge planning includes discussing the changes that need to be included in the lifestyle to improve the health and referrals that can be utilized by the patient in case of any emergency. The post-discharge plan will also include the information concerning the approaches that can be used to implement the changes in the daily routine which are necessary to reduce fluctuation in the health status. The family understanding concerning the patient condition is also important to understand their relevant role in the care of the patient (Pellett, 2016). The post-discharge planning of Sarah will include the information concerning the referrals that are important for the future help that can be used in future for help. The dietician and aerobics instructor referrals can also be done to help Sarah to reduce the weight that is important to decrease complication associated with obesity.

Conclusion on Sarah Brown Post-Operative Care Case Study

The report can be concluded by adding that patient condition indicates that there is a need to address the pain, decreased blood pressure, respiratory discomfort and decrease urine output. These complications are directly associated with the post-operative condition thus need immediate attention to decrease the chances of any metabolism issue. The complication that can be encountered by the patient includes myocardial ischemia and pulmonary embolism. The discharge plan will include information concerning the medication, lifestyle modification and health status. The discharge plan will also include the information concerning the referrals and information implementation approach to improving the lifestyle. 

References for Sarah Brown Post-Operative Care Case Study

Agnelli, G. & Becattini, C. (2015). Anticoagulant treatment for acute pulmonary embolism: A pathophysiology-based clinical approach. European Respiratory Journal, 45(4), 1142–1149. DOI: 10.1183/09031936.00164714 

Chumkam, A., Pongrojpaw, D., Chanthasenanont, A., Pattaraarchachai, J., Bhamarapravatana, K. & Suwannarurk, K. (2019). Cryotherapy reduced postoperative pain in gynecologic surgery: A randomized controlled trial. Pain Research and Treatment, 2019, 1–6. DOI:10.1155/2019/2405159 

Coffey, A., Leahy-Warren, P., Savage, E., Hegarty, J., Cornally, N., Day, M. R., Sahm, L., O'Connor, K., O'Doherty, J., Liew, A., Sezgin, D. & O'Caoimh, R. (2019). Interventions to promote early discharge and avoid inappropriate hospital (re) admission: A systematic review. International Journal of Environmental Research and Public Health16(14), 1-16. DOI: 10.3390/ijerph16142457

Heusch, G. (2016). Myocardial Ischemia. Circulation Research, 119(2), 194–196. DOI:10.1161/circresaha.116.308925 

Kang, Y. & Demiris, G. (2018). Self-report pain assessment tools for cognitively intact older adults: Integrative review. International Journal of Older People Nursing13(2). DOI: 10.1111/opn.12170

Kawamura, A., Kajiya, K., Kishi, H., Inagaki, J., Mitarai, M., Oda, H., Umemoto, S. & Kobayashi, S. (2018). The nutritional characteristics of the hypotensive washoku-modified dash diet: A sub-analysis of the dash-jump study. Current Hypertension Reviews14(1), 56–65. DOI: 10.2174/1573402114666180405100430

Keto, J., Ventola, H., Jokelainen, J., Linden, K., Keinänen-Kiukaanniemi, S., Timonen, M., Ylisaukko-Oja, T. & Auvinen, J. (2016). Cardiovascular disease risk factors in relation to smoking behaviour and history: A population-based cohort study. Open Heart3(2), 1-9. DOI: 10.1136/openhrt-2015-000358

Klein, S. J., Lehner, G. F., Forni, L. G. & Joannidis, M. (2018). Oliguria in critically ill patients: A narrative review. Journal of Nephrology31(6), 855–862. DOI: 10.1007/s40620-018-0539-6

Merry, A. F. & Mitchell, S. J. (2018). Complications of anaesthesia. Anaesthesia, 73, 7–11. DOI: 10.1111/anae.14135 

Morici, B. (2014). Diagnosis and management of acute pulmonary embolism. Journal of the American Academy of Physician Assistants, 27(4), 18–22. DOI: 10.1097/01.jaa.0000444729.09046.09 

Nordmark, S., Zingmark, K. & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC Medical Informatics and Decision Making16(48), 1-10. DOI: 10.1186/s12911-016-0285-4

Osman, A. M., Carter, S. G., Carberry, J. C. & Eckert, D. J. (2018). Obstructive sleep apnea: Current perspectives. Nature and Science of Sleep10, 21–34. DOI: 10.2147/NSS.S124657

Patel, P. R. & Bechmann, S. (2020). Discharge Planning. Treasure Island, United Kingdom: StatPearls Publishing.

Pellett, C. (2016). Discharge planning: Best practice in transitions of care. British Journal of Community Nursing, 21(11), 542–548. DOI:10.12968/bjcn.2016.21.11.542 

Righini, M., Robert-Ebadi, H. & Le Gal, G. (2017). Diagnosis of acute pulmonary embolism. Journal of Thrombosis and Haemostasis, 15(7), 1251–1261. DOI:10.1111/jth.13694 

Sattar, Y. & Chhabra, L. (2020). Electrocardiogram. Treasure Island, United Kingdom: StatPearls Publishing.

Schiff, J. H., Welker, A., Fohr, B., Henn-Beilharz, A., Bothner, U., Van Aken, H. & Heinrichs, W. (2014). Major incidents and complications in otherwise healthy patients undergoing elective procedures: Results based on 1.37 million anaesthetic procedures. British Journal of Anaesthesia, 113(1), 109–121. DOI: 10.1093/bja/aeu094

Smith, J. B., Pittet, J. F. & Pierce, A. (2014). Hypotensive resuscitation. Current Anesthesiology Reports4(3), 209–215. DOI: 10.1007/s40140-014-0064-7

Steg, P. G., & De Silva, R. (2014). Beta-blockers in asymptomatic coronary artery disease. Journal of the American College of Cardiology, 64(3), 253–255. DOI: 10.1016/j.jacc.2014.04.043

Tartari, E., Weterings, V., Gastmeier, P., Rodríguez Baño, J., Widmer, A., Kluytmans, J. & Voss, A. (2017). Patient engagement with surgical site infection prevention: an expert panel perspective. Antimicrobial Resistance and Infection Control6, 45. DOI: 10.1186/s13756-017-0202-3

Ünver, S., Kıvanç, G. & Alptekin, H. M. (2018). Deep breathing exercise education receiving and performing status of patients undergoing abdominal surgery. International Journal of Health Sciences12(4), 35–38.

Vincent, J.-L., Ferguson, A., Pickkers, P., Jakob, S. M., Jaschinski, U. & Sakr, Y. (2020). The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database. Critical Care, 24(1). DOI:10.1186/s13054-020-02858-x 

Wadden, T. A., Webb, V. L., Moran, C. H. & Bailer, B. A. (2012). Lifestyle modification for obesity: New developments in diet, physical activity, and behavior therapy. Circulation125(9), 1157–1170. DOI: 10.1161/CIRCULATIONAHA.111.039453

Yamamoto-Morimoto, K., Horibe, S., Takao, R. & Anami, K. (2019). Positive effects of yoga on physical and respiratory functions in healthy inactive middle-aged people. International Journal of Yoga12(1), 62–67. DOI: 10.4103/ijoy.IJOY_10_18

Yancey R. (2018). Anesthetic management of the hypertensive patient: Part i. Anesthesia Progress65(2), 131–138. DOI: 10.2344/anpr-65-02-12

Zakhary, W. Z. A., Turton, E. W. & Ender, J. K. (2017). Post-operative patient care and hospital implications of fast track, European Heart Journal Supplements, 19(1), A18–A22, DOI: 10.1093/eurheartj/suw055

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