Application of Clinical Reasoning Skills for Clinical Patient Scenario

1.1 Pathophysiology of Acute Pain

Pain is common among patients and that need medical attention and care. The reasons could be due to various reasons, but it creates devastating disabilities. When an abnormal somatosensory system gets affected, it causes acute pain. Pain is often associated with both emotional and sensory components. Tolerance ability of pain varies from people to people. There are various factors that causes pain and that can be described in its pathophysiology. Skin along with subcutaneous tissues consists of somatic pain receptor. Any kind of injury would stimulate these receptors and produces dull or sharp pain based on the type of injury. Ideally, this type of pain is localized. Visceral pain is caused to the stimulation of the receptors present in the viscera and the areas surrounding the connective tissues (Sommer, C., Leinders, M., & Üçeyler, N. (2018). Any kind of obstruction in the hollow organ or any injury to the organ capsule would create intense pain. It could be either localized or may speared to a wider area.

Intensity and pain modulation are associated with the psychological factors like emotions and thoughts. Ideally, chronic pain is caused due to depression, psychological distress and anxiety as they are directly related with the pain perception. Impairment of multiple cognitive aspects and domains like loss of attention, concentration, memory, thought, etc. are associated with this type of pain. Once pain is created, it undergoes modulation and transmission where the role of the pain fibres presents in the dorsal root ganglia and synapse tat carry the signal to the brain’s thalamus followed by cerebral cortex. Prolonged pain is the outcome of the repetitive stimulation of the neuron sensitization, producing long-term synaptic changes. When an area gets injured, it cascades the inflammation that sensitize the peripheral nociceptors along with other pain modulators

Pain can be classified as acute pain and chronic pain. Hyperactivity of the sympathetic nervous system along with anxiety are the characteristics of the acute pain. It includes increase in the blood pressure, heart rate, respiratory rate, dilated pupils, etc. On the other hand, chronic pain is associated with vegetative signs and does not include activation of the sympathetic nervous system. It is also associated with depression of mood along with loss of appetite (Van Vulpen, L. F. D., Holstein, K., & Martinoli, C. (2018). Libido, fatigue, etc. In Trans who had undergone ileostomy, the cause of pain would be visceral. Visceral pain is caused to the stimulation of the receptors present in the viscera and the areas surrounding the connective tissues. Any kind of obstruction in the hollow organ or any injury to the organ capsule would create intense pain. It could be either localized or may speared to a wider area. Narcotic analgesia would help in suppressing the pain for a certain period.

1.2 Nursing Assessment for Tran’s Deterioration

Priority assessment includes detailed clinical assessment of patient who might have undergone emergency or is in the verge of going for an emergency. At this time, it is essential to take a quick information of the patient and ensuring relative stability of the patient and listing out the priorities for patient care (Justiniano, C. F., Temple, L. K., Swanger, A. A., Xu, Z., Speranza, J. R., Cellini, C., ... & Fleming, F. J. (2018). Priority assessments is also applicable for the deteriorating patient and such patient could be identified by three basic assessment i.e. Listen, Look and Feel.

  • Listening the breathing patterns and rate of the patient with the help of stethoscope or even through an auscultate and identifying the airways of the patient’s has been affected

  • Looking towards the rhythm, rate and depth of the respiration of the patients for about on minute and collecting data

  • Feeling the palpitation of the chest of the patient

Acting on the surgical site for its dressing and keeping that intact is also one of the important aspects of the priority assessment and this needs to be checked for Trans. Postoperative care is highly critical as the healing and recovery rate of the patient depends on the type and extent of care they are been provided. Some of the major considered that needs to be considered for a deteriorating patient include systematic assessment that help in taking timely and appropriate action that could help in limiting further deterioration. Three types of nursing assessments tat need to be done for Trans to access his deterioration level includes,

  • Percussion – It is the process of assessing the location and size of the abdominal organs along with the amount of air and fluid present in that rea. It will help in identifying the reason of pain along with planning the proper treatment plan.

  • Abdominal Assessment - It is mostly the external inspection of the surgical site, peristalsis, contour and integrity of skin. Size and welling of the abdomen are also analysed here (Justiniano, C. F., Temple, L. K., Swanger, A. A., Xu, Z., Speranza, J. R., Cellini, C., ... & Fleming, F. J. (2018).

  • Palpitation Assessment – This assessment helps in providing clues about the condition pf the abdominal area of surgery along with the density, etc. palpitation utilizes three techniques and those are, light, deep and ballottement. Most of them can be done externally and would help in determine the condition of patient.

1.3 Nursing Interventions for Post-Operative Ileostomy

Post-Operative Ileostomy required lot of care and attention so that it does not relapse or affect the patient in inducing pain or getting prone to some kind of infections. This surgery changes the path of the waste removal from the body in an artificial manner through a stoma. It is a small opening in the belly of the patient through which the stool or the body waste passes and goes into a pouch from where it is collected. This needs to be changed multiple times a day and thus is highly prone to infection if utmost care is not taken (Bednarski, B. K., Slack, R. S., Katz, M., You, Y. N., Papadopolous, J., Rodriguez-Bigas, M. A., ... & Chang, G. J.

(2018). Nursing care for the Post-Operative Ileostomy patients including some major focus like preventing any kind of complication in the form of infection., assisting patients with the daily activities along with adjustments, providing information about any kind of prognosis or procedures, evaluating the treatment needs and evaluating the potential complications so that immediate actions could be taken for managing and irradiating the same.

Considering the case of Trans, the nursing intervention that would be applicable for his condition and situation are,

  • Verifying the opening of the adhesive that helps in backing the pouch. The opening should be between 2-3 mm and should be larger than the base of the stoma along with having adequate adhesive left applied in the pouch.

Rationale – This will help in preventing any kind of traumatic stress to the stoma tissue and will also help in protecting the peristomal skin. Presence of adequate adhesive in the affected areas would help in preventing the skin barrier wafer form getting to be too tight as too much tightness would cause stenosis or stomal oedema.

  • Investigating and reporting any kind of itching, burning or occurrence of any kind of blisters in the affected area or around the stoma

Rationale – Effluent or indicative leakage is common in this case along with peristomal irritation that could be due to some kind of infection or even due to some external friction or due to wrong adjustments. This could also lead to candida infection and if not managed on time could lead to organ damage or even deadly consequences

  • Pain management along with checking for obstruction or blockage

Rationale – Watching for any kind of selling and other abnormalities in the effected area. Acting on the surgical site for its dressing and keeping that intact is also one of the important aspects of the priority assessment and this needs to be checked for Trans. Postoperative care is highly critical as the healing and recovery rate of the patient depends on the type and extent of care they are been provided.

1.4 Pain Management

Intensity and pain modulation are associated with the psychological factors like emotions and thoughts. Ideally, chronic pain is caused due to depression, psychological distress and anxiety as they are directly related with the pain perception. Impairment of multiple cognitive aspects and domains like loss of attention, concentration, memory, thought, etc. are associated with this type of pain. Once pain is created, it undergoes modulation and transmission where the role of the pain fibres presents in the dorsal root ganglia and synapse that carry the signal to the brain’s thalamus followed by cerebral cortex (Bednarski, B. K., Slack, R. S., Katz, M., You, Y. N., Papadopolous, J., Rodriguez-Bigas, M. A., ... & Chang, G. J. (2018).

Prolonged pain is the outcome of the repetitive stimulation of the neuron sensitization, producing long-term synaptic changes. When an area gets injured, it cascades the inflammation that sensitize the peripheral nociceptors along with other pain modulators. Pain can be classified as acute pain and chronic pain. Hyperactivity of the sympathetic nervous system along with anxiety are the characteristics of the acute pain. It includes increase in the blood pressure, heart rate, respiratory rate, dilated pupils, etc. On the other hand, chronic pain is associated with vegetative signs and does not include activation of the sympathetic nervous system (Justiniano, C. F., Temple, L. K., Swanger, A. A., Xu, Z., Speranza, J. R., Cellini, C., ... & Fleming, F. J. (2018).

This surgery changes the path of the waste removal from the body in an artificial manner through a stoma. It is a small opening in the belly of the patient through which the stool or the body waste passes and goes into a pouch from where it is collected. This needs to be changed multiple times a day and thus is highly prone to infection if utmost care is not taken. Nursing care for the Post-Operative Ileostomy patients including some major focus like preventing any kind of complication in the form of infection., assisting patients with the daily activities along with adjustments, providing information about any kind of prognosis or procedures, evaluating the treatment needs and evaluating the potential complications so that immediate actions could be taken for managing and irradiating the same.

1.5 Major Side Effects of Intravenous Morphine

Postoperative care is highly critical as the healing and recovery rate of the patient depends on the type and extent of care they are been provided. Some of the major considered that needs to be considered for a deteriorating patient include systematic assessment that help in taking timely and appropriate action that could help in limiting further deterioration (Ding, H., Kiguchi, N., Yasuda, D., Daga, P. R., Polgar, W. E., Lu, J. J., ... & Ko, M. C. (2018). It is essential to take a quick information of the patient and ensuring relative stability of the patient and listing out the priorities for patient care. Morphine is one of the best choices of drug for pain management. Some of the common side-effects of the Intravenous Morphine includes shortness of the breath along with slowing down of the breathing rate.

Paling of skin along with fingernails and blue coloration of the lips. Facing difficulties in breathing along with blurredness in vision (Lamontagne, F., Fowler, R. A., Adhikari, N. K., Murthy, S., Brett-Major, D. M., Jacobs, M., ... & Fletcher, T. E. (2018). Dizziness, fainting and irregular heartrate are also common. Overdosing could lead to depersonalization, anxiety, severe headaches, hallucinations, etc. many patients has reported of skin irritation and allergies also.

References

Bednarski, B. K., Slack, R. S., Katz, M., You, Y. N., Papadopolous, J., Rodriguez-Bigas, M. A., ... & Chang, G. J. (2018). Assessment of ileostomy output using telemedicine: a feasibility trial. Diseases of the Colon & Rectum, 61(1), 77-83.

Chen, S. Y., Stem, M., Cerullo, M., Canner, J. K., Gearhart, S. L., Safar, B., ... & Efron, J. E. (2018). Predicting the risk of readmission from dehydration after ileostomy formation: The DRIP score. Diseases of the colon and rectum, 61(12), 1410.

Ding, H., Kiguchi, N., Yasuda, D., Daga, P. R., Polgar, W. E., Lu, J. J., ... & Ko, M. C. (2018). A bifunctional nociceptin and mu opioid receptor agonist is analgesic without opioid side effects in nonhuman primates. Science translational medicine, 10(456).

Justiniano, C. F., Temple, L. K., Swanger, A. A., Xu, Z., Speranza, J. R., Cellini, C., ... & Fleming, F. J. (2018). Readmissions with dehydration after ileostomy creation: rethinking risk factors. Diseases of the colon and rectum, 61(11), 1297.

Kang, E., Gillespie, B. M., Tobiano, G., & Chaboyer, W. (2018). Discharge education delivered to general surgical patients in their management of recovery post discharge: a systematic mixed studies review. International journal of nursing studies, 87, 1-13.

Landerholm, K., Wood, C., Bloemendaal, A., Buchs, N., George, B., & Guy, R. (2018). The rectal remnant after total colectomy for colitis–intra-operative, post-operative and longer-term considerations. Scandinavian journal of gastroenterology, 53(12), 1443-1452.

Lamontagne, F., Fowler, R. A., Adhikari, N. K., Murthy, S., Brett-Major, D. M., Jacobs, M., ... & Fletcher, T. E. (2018). Evidence-based guidelines for supportive care of patients with Ebola virus disease. The Lancet, 391(10121), 700-708.

Rojanasarot, S. (2018). The impact of early involvement in a postdischarge support program for ostomy surgery patients on preventable healthcare utilization. Journal of Wound, Ostomy, and Continence Nursing, 45(1), 43.

Sabbagh, C., Rebibo, L., Hariz, H., & Regimbeau, J. M. (2018). Stomal construction: technical tricks for difficult situations, prevention and treatment of post-operative complications. Journal of visceral surgery, 155(1), 41-49.

Sommer, C., Leinders, M., & Üçeyler, N. (2018). Inflammation in the pathophysiology of neuropathic pain. Pain, 159(3), 595-602.

Van Vulpen, L. F. D., Holstein, K., & Martinoli, C. (2018). Joint disease in haemophilia: Pathophysiology, pain and imaging. Haemophilia, 24, 44-49.

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

Get It Done! Today

Applicable Time Zone is AEST [Sydney, NSW] (GMT+11)
Not Specific >5000
  • 1,212,718Orders

  • 4.9/5Rating

  • 5,063Experts

Highlights

  • 21 Step Quality Check
  • 2000+ Ph.D Experts
  • Live Expert Sessions
  • Dedicated App
  • Earn while you Learn with us
  • Confidentiality Agreement
  • Money Back Guarantee
  • Customer Feedback

Just Pay for your Assignment

  • Turnitin Report

    $10.00
  • Proofreading and Editing

    $9.00Per Page
  • Consultation with Expert

    $35.00Per Hour
  • Live Session 1-on-1

    $40.00Per 30 min.
  • Quality Check

    $25.00
  • Total

    Free
  • Let's Start

Get
500 Words Free
on your assignment today

Browse across 1 Million Assignment Samples for Free

Explore MASS
Order Now

Request Callback

My Assignment Services- Whatsapp Tap to ChatGet instant assignment help

Hire Certified Experts
Ask your Question
Need Assistance on your
existing assignment order?

We care

MyAssignmentServices uses cookies to deliver the best experience possible.
My Assignment Services acknowledges the academic integrity guidelines prescribed as per Australian Universities to ensure that the services, sample material, and study resources available on our website, in no way are utilised to commit academic misconduct of any type. All users of our services must adhere to and affirm acceptance of all conditions elucidated in our policy document on academic integrity.

Please accept and affirm the following to be able to continue exploring our website and services: I agree to NOT use any educational material, study resources, assignment samples, online mentoring services, available on the web domain www.myassignmentservices.com and all its subdomains to commit any academic misconduct. I have read and been made fully aware of the academic integrity policy of My Assignment Services and by clicking on the button below, I am in principle, wilfully and legally bound to adhere to guidelines of the academic integrity policy in whole and in part.
View Cookies policy | How we ensure Academic Integrity?