Contexts of Practice: Complex Care

Introduction to Mr. John Douglas Abdominal Distension Case Study

The case study is about a 70-year-old Mr John Douglas and he has admitted with a complaint of nausea and vomiting from the past 4 days. His vitals reveal increased temperature, increased heart rate and low blood pressure. The major issue identified after observation is pain 7/10 and he has not opened his bowel from past 4 days with abdominal distension. The medical history of the patient reveals that diverticulitis with right carpal tunnel repair.

Systemic Assessment

The different assessment that can help to identify further complication concerning the patient medical, as well as lifestyle history, includes 

  • CNS assessment: The patient family history reveals that he is divorced and has no children that indicate he is living alone that directly increases the chance of the depression. The depression assessment is necessary to improve understanding regarding the mental state of the patient. The article presented by Maurer et al. (2018, p.508) describes the importance of depression screening tool in the individual living lonely so that proper assistance can be provided to reduce the chances of complication. Different risk factors can lead to depression-like divorce and disturbed family environment. Patient Health Questionnaire is used to identify the depression in the patient by utilizing the different question to evaluate patient mental status.
  • CVS assessment: The increase heart rate and deteriorated blood pressure indicate the disturbance in the cardiac functioning that can be a sign for any complication. ECG can be done to identify the issue in the heart functioning so that proper intervention can provide to reduce the chances of complication. The study presented by Reichlin et al. (2016, p.1) describes that it is important to understand the state of the heart by analyzing the electrical signals generated by the cells. ECG assessment is considered to be important as it is helpful to diagnosis different complication that can be encountered by the patient like myocardial ischemia, chamber hypertrophy or cardiac arrhythmias. The different symptoms like shortness of breath, chest pain, increased heart rate and fluctuation in blood pressure are the reason for the disturbance that can be traced by the ECG.
  • RESP assessment: The lifestyle information of the patient reveals that he is a smoker from the past 30 years and he smokes a packet of cigarette in one day that can increase the risk for respiratory complication. The spirometer assessment is important to evaluate the lung capacity that directly reflects the presence of any disorders. It was also supported by Kociánová et al. (2018, p.889) by adding that the spirometer test is important to measure the maximal volume of air concerning inspire and expire with maximal effort. The patient having any medical lifestyle pattern that can directly affect the respiratory health should undergo spirometer assessment to identify the issue.
  • ABDO assessment: Different symptoms directly indicate an abnormality in the abdomen or the intestine concerning the case study like nausea vomiting and abdominal pain. Gastrointestinal assessment can help to identify the issue with the patient digestive tract that is increasing his complication. One of the studies presented by Koloski et al. (2017, p. 1913) discussed that focused gastrointestinal assessment is important to identify the issue that leads to the prognosis of the symptoms. The different assessments that are included in the gastrointestinal assessment include nutritional assessment, physical examination and PQRST Assessment. The assessment reveals different readings that are important for evaluating patient health status. The gastrointestinal assessment will help to identify the issues that are necessary to frame the intervention as per patient health status.

The patient current assessment reveals that he has not opened bowels for 4 days and he has also examined with the abdominal distension. The medical history of the patient also reveals that he has also suffered from the diverticulitis that on complication can lead to bowel obstruction. The colonoscopy is important to identify the obstruction in the intestine that is necessary to treat the patient accordingly. The study presented by Kastenberg et al. (2018, p.2833) describe that colonoscopy help to evaluate the polyps, cancer or other diseases that can increase complication for the patient. It is the endoscopic examination that helps to evaluate the bowel by the CCD camera that directly pas through the anus.

  • Renal assessment: Urine strip analysis will be conducted to identify any renal issue that can directly deteriorate the health status of the patient. The renal system issue can directly impact over the body system thus it is important to trace the issue (Oyaert & Delanghe, 2019, p.1)

Priorities of Treatment

The priority that needs immediate attention as per the patient condition is the abdominal pain that is of about 7/10. The abdominal pain can be addressed by relaxation techniques. One of the article presented by Norton et al. (2017, p.115) describe that relaxation technique is useful to improve the abdominal pain of the patient that directly reduce the health-related complication. The relaxation intervention includes psychological intervention followed by dietary intervention to reduce the pain and improve comfort. The psychological intervention includes cognitive therapy, distraction method, biofeedback process and behavioural therapy. The dietary intervention includes managing the daily intake of the calories and managing its energy expenditure.

According to Kooienga & Wilkinson (2016, p.3), Registered nurses are expected to collaborate with the patient during the care to improve the understanding of the patient concerning the treatment that will improve patient participation. The nurse can assist the patient to understand the different aspect of relaxation technique to improve the results and better patient health.

Nausea and vomiting are the major complaints of the patient during the admission to the emergency department. He was facing an issue with nausea and vomiting from the past four days that has increased his complication. Droperidol is one of the medications that are utilized for treating nausea and vomiting that is increasing complication for the patient. The article presented by Lai & Huang (2018, p.1) describe that droperidol is the short-acting butyrophenone that has an antiemetic and antipsychotic effect. It is completely absorbed after the intramuscular administration that led to extensive metabolism of the drug. It directly works by blocking the dopamine receptors that are responsible for the chemoreceptor trigger and it leads to nausea or vomiting. The study presented by Salmond & Echevarria (2017, p.12) describes that changed healthcare and increase the role of Registered nurse to improve the care process. The registered nurses are expected to assist the patient in the care by indulging in the intervention, medication and follow-ups. The nurse can help the patient with maintaining the routine of medication concerning the doctor prescription and reduce the chances of side effect that can occur as per the medication.

The decrease in blood pressure should also be immediately addressed to improve patient health status. Hypotensive resuscitation is one of the methods that can be used to address the hypotension state and reduce the chances of complication. The study presented by Finfer et al. (2018, p.541) discusses that intravenous fluid therapy is important to improve the electrolyte balance in the individual that is necessary for blood pressure maintenance. The state occurs when there is misbalance in the homeostasis of the electrolyte that leads to decrease absorption which causes a drop in the blood pressure. The patient with hypotension state should immediately be provided with fluid therapy to decrease the chances of complication. According to Birks et al. (2016, p.522), the registered nurse is considered to be the backbone of the patient care system and they have to follow the professional practice to improve quality of care. The nurse can help to explain the importance of the treatment followed by keeping an eye to decrease the chances of any complication.

The closures of the bowel from last four days also require attention as it can increase the complication for the patient. The article presented by Loftus et al. (2015, p. 13) describe that the nasogastric tube is used to treat the bowel obstruction that is increasing complication for the patient. The fine tube is inserted to the stomach that is used to drain out the stomach content and decompress the stomach that is important to improve the bowel movement. The nasogastric tube will help to decrease the complication that has occurred due to the decrease or blocked bowel movement and it assists the patient to improve the bowel routine. The study conducted by Powers et al. (2019, p.131) describe that patient care is incomplete with the registered nurse as they are considered to be an integral part of the care. The registered nurses are considered to maintain a rapport with the client that is important for the care. The nurse should continuously follow with the client and should help the client to understand the procedure with its importance.

The fever is also observed in the patient after the assessment thus there is a need to lower down his body temperature to improve the health status of the patient. Acetaminophen is one of the drugs that can help to decrease body temperature and decrease complication. One of the studies presented by Young et al. (2015, p.2215) discussed how acetaminophen is preferred by the health care professionals to reduce the temperature that is necessary for the patient. It works by blocking the cycloxygenase in the brain that directly decreases the release of prostaglandin in CNS this lead to the antipyretic effect. The decrease in body temperature is necessary to improve the health status of the patient that is important to decrease the recovery time. The study presented by Norful et al. (2017, p.15) discusses the role of registered nurses in primary care and their impact over the patient health status. Primary care requires a registered nurse to play an integral role that aims to provide quality care that assists the patient. The nurse can help the patient to routinely monitor the fever and evaluate the side effect of the medicine that needs urgent attention.

The increased heart rate can increase the risk of heart-related disorders that can be dangerous for the patient. The increased heart rate should be immediately addressed to decrease the chance of complication that can deteriorate the health status of the patient. One of the studies presented by Al-Majed et al., (2017, p.287) discuss that propranolol is one of the medicines that is utilized to decrease the racing heart rate that is not suitable for the patient. They selectively block Beta 1 receptors in the heart that decrease the force of the contraction. According to Campagna et al. (2019, p.297), the registered nurse is important to provide quality care to the patient. The nurse can help the patient to understand the importance of medication and routine so that heart rate can be managed.

Discharge Planning

The social justice frameworks provide services are such a way that aims to reduce inequality and provide a supportive environment to the population. The three actions that are covered in the social justice framework include enabling, mediating and advocating. The social justice framework is important to improve equity in the services that help the individual to get person-centred services (Fleck-Henderson & Belkin Martinez, 2014). The discharge planning demands better communication so that proper exchange of information can be done to improve patient understanding regarding the care. The discharge planning should include the participation of the nurse, patient and doctor that proper information can be transferred to the patient concerning the care. The discharge plan should include all the information regarding the treatment process, medication and current health status (New et al., 2016, p.57).

The patient discharge plan should include information regarding the current treatment process and their outcomes. The current health status like vitals, bowel status, pain and blood pressure should be included in the discharge plan. The lifestyle and dietary modification that is recommended to the patient like calories intake and mild exercise should be included in the plan. The patient discharge plan will also include certain things and dietary material that needs to be avoided to maintain health status. The different referrals will also be included in the discharge plan so that patient can refer in case of any emergency so that proper assistance can be provided to the patient.

References for Mr. John Douglas Abdominal Distension Case Study

Al-Majed AA, Bakheit AHH, Abdel Aziz HA, Alajmi FM & AlRabiah H 2017. ‘Propranolol’, Profiles Drug Substance Excip Relation Methodology, vol. 42, pp. 287-338. https://doi.org/10.1016/bs.podrm.2017.02.006.

Campagna V, Nelson SA & Krsnak J 2019. ‘Improving care transitions to drive patient outcomes: The triple aim meets the four pillars’, Professional Case Management, vol. 24, no. 6, pp. 297-305. https://doi.org/10.1097/NCM.0000000000000387

Finfer S, Myburgh J & Bellomo R 2018. ‘Intravenous fluid therapy in critically ill adults [published correction appears in Nat Rev Nephrol’, National Review of Nephrology, vol. 14, no. 9, pp. 541-557. https://doi.org/10.1038/s41581-018-0044-0

Fleck-Henderson A & Belkin Martinez D 2014. ‘Social justice in clinical practice: A liberation health framework for social work’. https://doi.org/10.4324/9781315813073

Kastenberg D, Bertiger G & Brogadir S 2018. ‘Bowel preparation quality scales for colonoscopy’, World Journal of Gastroenterology, vol. 24, no. 26, pp. 2833-2843. https://doi.org/10.3748/wjg.v24.i26.2833

Kociánová J 2018. ‘Spirometrie - základní vyšetření funkce plic [Spirometry - basic examination of the lung function’, Vnitr Lek, vol. 63, no. 11, pp.889-894.

Koloski NA, Jones M, Hammer J 2017. ‘The validity of a new structured assessment of gastrointestinal symptoms scale (SAGIS) for evaluating symptoms in the clinical setting’, Dig Dis Sci, vol.62, no. 8, pp. 1913-1922. https://doi.org/10.1007/s10620-017-4599-6.

Kooienga S & Wilkinson J 2016. ‘RN prescribing: An expanded role for nursing’, Nursing Forum, vol. 52, no. 1, pp. 3–11. https://doi.org/10.1111/nuf.12159.

Lai PC & Huang YT 2018. ‘Evidence-based review and appraisal of the use of droperidol in the emergency department’. Ci Ji Yi Xue Za Zhi, vol. 30, no. 1, pp. 1-4. https://doi.org/10.4103/tcmj.tcmj_195_17

Maurer DM, Raymond TJ & Davis BN 2018. ‘Depression: Screening and diagnosis’, American Family Physician, vol. 98, no.8, pp. 508-515.

New PW, McDougall KE & Scroggie CP 2016. ‘Improving discharge planning communication between hospitals and patients’. International Medical Journal, vol. 46, no. 1, pp. 57-62. https://doi.org/10.1111/imj.12919

Norful A, Martsolf, G, de Jacq K & Poghosyan L 2017. ‘Utilization of registered nurses in primary care teams: A systematic review’. International Journal of Nursing Studies, vol. 74, pp. 15–23. https://doi.org/10.1016/j.ijnurstu.2017.05.013

Norton C, Czuber-Dochan W, Artom M, Sweeney L & Hart A. 2017. ‘Systematic review: Interventions for abdominal pain management in inflammatory bowel disease’, Aliment Pharmacological Therapy, vol. 46, no. 2, pp. 115-125. https://doi.org/10.1111/apt.14108

Oyaert M & Delanghe JR 2019. ‘Semiquantitative, fully automated urine test strip analysis’ Journal of clinical laboratory analysis, vol.33, no. 5, pp.1-7 https://doi.org/10.1002/jcla.22870

Reichlin T, Abächerli R & Twerenbold R 2016. ‘Advanced ECG in 2016: Is there more than just a tracing’, Swiss Medical Weekly, vol. 146, no.14303. https://doi.org/10.4414/smw.2016.14303

Salmond SW & Echevarria M. 2017. ‘Healthcare Transformation and Changing Roles for Nursing’. Orthopedic Nursing, vol. 36, no. 1, pp. 12-25. https://doi.org/10.1097/NOR.0000000000000308.

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