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  • Subject Name : Nursing

Communicating with the SBER

Situation

Fred is an 89-year-old man who after 5 days of surgery has experienced bowel formation of short-term colostomy. Fred has a prior medical history of cardiovascular diseases such as heart attack, type II diabetes Mellitus, gout, and obesity (BMI 37. 6 m2, Height 176cm, weight 115 kgs). Fred is a widower whose currents lives in foster care. Fred has two grown-up children who live overseas with their wives and sons, Chris and Charles. Fred vital signs at 11am were as follows: T 38.2; HR 98reg; BP134/85; RR 27; SpO2 94% o 3L NP. Fred was feeling pain that he described at a scale of 5/10, saying that the pain worsens with palpation to 6/10, the nurse notes that his abdomen is distended. Fred exhibits bowel sounds that have not passed the flatus. The patient has PCA-Morphin in situ for pain management. The stoma is moist, pink, warm and the skin is slightly raised through the bag. The abdominal laparotomy has an opposite; with minimal ooze present

Background

Fred had previously undergone biopsy and colonoscopy, which malignant mass was identified. The patient had undergone colorectal surgery and has increased chances of reduction in favourable oncological outcomes with compounded complications leading to a reduced overall quality of life. The current medication that the patient was using is Metformin 500g. Mane, Catootil 12.6mg mane, and metformin. Yesterday, he had lamented of full fluid diet and has upgraded. Patients who have undergone colorectal surgery have higher risks of getting postoperative complications. The increased number of laparotomy surgery was 17% (Joris et al., 2015). Psychological factors such as anxiety and fear can cause biological and physical pain

Assessment

Fear and uncertainties regarding surgical procedures normally make people stressed. That is why controlling stress is warranted and justified for the improvement of the recovery process. Due to readmission to the hospital, the patient was confused and anxious about the post-operative complications he had developed. Since Fred had undergone biopsy which shown mass that is malignant necessitates care. In this case, offering education on post-operative pain and wound treatment will help the patient to feel relaxed-optimal pain management and control by favouring non-pharmacological approaches.

The process of maintaining the balance of fluid is of at most concern. Failure to address this problem may result in the development of gastrointestinal issues, which have the potential to escalate fast. The maintenance of the gastrointestinal juices is done by increased electrolyte intake, particularly potassium and sodium. The lack of coping consists of some of the most severe comorbidities that coexist. As such, the exuberance of pain is more severe when the two are present (Darbari & Brandow, 2017).

Additionally, the control of stress via non-pharmacological means is key to bolstering the recovery process. The patient is evidently in shock because of readmission and fear of the unknown. The use of therapy sessions that are accompanied by educational content on wound care will be of merit. The stabilisation of the vital signs and controlling pain is of utmost importance, especially for colonoscopy surgical patients (Amani et al., 2016). The provision of therapy, in this case, will help with the learning of coping mechanisms of the patient (Brown et al., 2013). The indication of post-operative pains in the abdomen is due to adhesions. Fred had problems with the skin area around the stoma.

Recommendation

The administration of Patient-Controlled Analgesia (PCA) accompanied by intermittent cognitive-based therapy sessions will provide long-term clinical benefits in this case. Although narcotics and opioids have short-term pain relief effect, their usage is not recommended in this case because of the unfavourable clinical events that culminate as side effects (Beck et al., 2015; Garimella & Cellini, 2013). Nurses should put more focus on evidence-based pain management as a post-operative measure (Joshi et al., 2013). The ultimate goal besides managing postoperative pain and controlling anxiety is maintaining equilibrium levels of fluids. To maintain tissue perfusion, the turgor of the skin must be maintained and capillary refill conducted.

Reflection of Health Assessment Techniques STARL

Situation

The patient was anxious amid having a medical history of cardiovascular disease cognitive-based therapy sessions are warranted. Since the patient was nervous and had confirmed the case of cardiovascular diseases, offering educational content pertaining to healthy lifestyle habits and well-being will provide him with the necessary support through the predicaments he was going through. Healthy lifestyle practices will ensure that the recovery process will be smooth and without further complications.

Task

The functions involved offering educational material that is targeted to their language. The provision of information materials to the patients in their penalised nature makes them comprehend the information more. A good understanding of how to manage the situation is critical for the patient treatment and recovery process; a language that they can understand will be important to ensure that everything is clear. Additionally, the task of offering wound and pain management while checking the stability of the vital sign is important.

Action

Monitor laboratory returns to Hydrochloric acid and electrolytes level to determine the fluid balance. Offering therapy sessions, as well as educational material to the patient, are also actions that will be performed. Monitoring should be done on patient pain reduction or exerbaration to measure progress. Therefore, it is important to carry out all these actions, in tandem with medication, in a manner that is precise and timely to ensure that the intended objective is attained. Obviously, this will lead to a positive outcome; smooth recovery from the condition suffered.

Results

The ultimate result is to maintain adequate or optimal fluid balance to maintain tissue perfusion so the wound can heal. A proper balance of fluid is critical since it is determining the flaccidity of the tissues. Another favourable outcome will be reduction of stress and anxiety. Pain reduction too coupled with the said desirable outcomes will provide long-term benefits to the patient by increasing his recovery. All through, the conditions favouring quick recovery should be monitored, and the right action is taken to ensure that predisposing condition is not triggered (cardiovascular), thereby exposing the client to further complications.

References

Asnani, M.R., Quimby, K.R., Bennett, N.R. and Francis, D.K. (2016). Interventions for patients and caregivers to improve knowledge of sickle cell disease and recognition of its related complications. Cochrane Database of Systematic Reviews, (10), 1-48.

Beck, D. E., Margolin, D. A., Babin, S. F., & Russo, C. T. (2015). Benefits of a multimodal regimen for postsurgical pain management in colorectal surgery. Ochsner Journal, 15(4), 408-412.

Brown, C., Constance, K., Bédard, D., & Purden, M. (2013). Colorectal surgery patients’ pain cell disease. Clinical Journal of Oncology Nursing, 16(6), 633.

Darbari, D. S., & Brandow, A. M. (2017). Pain-measurement tools in sickle cell disease: where are we now?. Hematology 2014, the American Society of Hematology Education Program Book, 2017(1), 534-541.

Garimella, V., & Cellini, C. (2013). Postoperative pain control. Clinics in Colon and Rectal Surgery, 26(03), 191-196.

Joris, J. L., Georges, M. J., Medjahed, K., Ledoux, D., Damilot, G., Ramquet, C. C., ... & Brichant, J. F. E. (2015). Prevalence, characteristics and risk factors of chronic postsurgical pain after laparoscopic colorectal surgery: retrospective analysis. European Journal of Anaesthesiology (EJA), 32(10), 712-717.

Joshi, G. P., Bonnet, F., Kehlet, H., & PROSPECT collaboration. (2013). Evidence‐based postoperative pain management after laparoscopic colorectal surgery. Colorectal Disease, 15(2), 146-155.

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