Assessment Nursing the gastrointestinal surgical patient
Assignment Objectives CLO 1. Evaluate the pathophysiological, pharmacotherapy and non-pharmacological management of acute exacerbation of illness, chronic diseases and complex conditions.
CLO 2. Evaluate the principles of professional nursing practice for people with diverse health concerns within the Australian contexts, including a selection of regional, rural and National Health Priorities across the lifespan including the needs of culturally diverse, disadvantaged, and vulnerable groups with acute, chronic and complex conditions.
Assessment Purpose The purpose of this assignment is to develop your critical thinking skills and clinical decision-making abilities in the care of a client with complex needs. In doing so, you are examining and applying the following standards for registered nurses for a patient episode of care. Read the case study below and answer the questions with subheadings in essay style
Standard 1: Thinks critically and analyses nursing practice.
RNs (Registered Nurses) use a variety of thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centred and evidence-based frameworks.
Standard 4: Comprehensively conducts assessments
RNs accurately conduct comprehensive and systematic assessments. They analyse information and data and communicate outcomes as the basis for practice.
Standard 6: Provides safe, appropriate, and responsive quality nursing practice.
RNs provide and may delegate, quality and ethical goal directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes.
Standard 7: Evaluates outcomes to inform nursing practice.
RNs take responsibility for the Assessment of practice based on agreed priorities, goals, plans and outcomes and revises practice accordingly Registered Nurse standards for practice Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Case Study Mr Ben Brown, a 68-year-old part-time landscape gardener presented to his GP (General Practitioner) four weeks ago with a 3-month history of abdominal pain and diarrhoea. A colonoscopy and CT (Computed Tomography) scan revealed extensive diverticular disease of the large bowel and a large tumour located in the ascending colon. Ben has been scheduled for an open right hemicolectomy.
Please refer to the following pre- and post-operative assessment data to answer the assignment questions.
Pre-operative clinical data
Objective Data Past Medical History Social History
• Weight 122 kgs
• Height reported 175 cm
• BP 155/100
• HR 88
• RR 18
• Temp 36.4C
• Urinalysis – normal
Current Medication
• Simvastatin 40mg nocte
• Captopril 100 mg mane
• Aspirin 100 mg mane
• Ventolin prn • Hypercholesterolemia
• Hypertension
• Asthma
• Obstructive sleep apnoea (OSA) confirmed with sleep study January 2011
• Uses CPAP (Continuous Positive Airway Pressure) machine at night
• Myocardial infarction (MI) 2007 with left coronary artery stenting • Married with 3 grown children
• Part-time landscape gardener
• Consumes 6 units of alcohol per day
• Independent with daily cares
• Smokes 10 cigarettes/day
Family history
• Father RIP bowel cancer
• Mother 84 years of age: myocardial infarction
Postoperative clinical data
Ben returned from theatre at 1900 following an open right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon. Lymph node metastasis was discovered in four of the 28 dissected lymph nodes.
You are the registered nurse looking after Ben on the early shift the day after his surgery. You have received handover at 0700 and are planning his care for the day.
Observations 0800 Medications Post-operative orders
• BP (Blood Pressure) 90/55mmHg
• Pulse: 110 and regular Respiratory rate: 12/min shallow SpO2 95% 2 litres via nasal prongs, Temperature 37.8°C Axilla,
• Sedation score = 2
• Vacudrain in-situ 400 mL in bag
• Estimated blood loss (EBL) in OT 600mL
• Urine output via a Foley IDC: 10-15 mls/hour <1mL/kg/hour last three hours • Pain score 6 on a scale of 0-10 • Midline abdominal dressing (minimal ooze) • Simvastatin 40mg nocte • Captopril 100 mg/day • Aspirin 100 mg mane • Fentanyl PCA (Patient Controlled Analgesia) 20mcg bolus: 5-minute lockout • Regular paracetamol 1G QID (PO/IV) • Tramadol 50-100mg QID prn (PO/IV) • Oxygen 2L via nasal prongs • Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 80mL/hour • IV Cefoxitin 2gms TDS • Midline abdominal dressing - leave intact • Nasogastric tube (NGT) 4/24 hourly aspiration • Mobilise day 1 with physiotherapist • Sips of clear fluid only • Remove IDC 1000, day 1 • DVT (Deep Vein Thrombosis) prophylaxis –TED stockings • Pain management • Oncology review 1/52. Will require adjuvant chemotherapy as an outpatient • GP follow up 2/52 • OPD appointment 4/52 with Dr McCormack Task description in detail This assignment requires you to consider the case scenario of Ben Brown who has undergone an open right hemicolectomy. Your answer will concentrate on the first 24 hours of post-surgical care and includes discharge planning 1. Provide an INTRODUCTION (approximately 100 words) An introduction will provide clear scope about the direction of your assignment. This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion. Part A: Analyse the case to identify potential clinical issues and relevant nursing care (1000 words) This section will focus on the first 24 hours of post-surgical care and involves prioritising nursing care for Ben. Consider Ben’s co-morbidities including obstructive sleep apnoea (OSA), previous MI, asthma, hypertension, and hypercholesterolemia in the context of having a general anaesthetic (GA) and in identifying your clinical issues. 1. Identify THREE (3) PRIORITY clinical issues for Ben e.g., at risk of severe pain 2. Identify NURSING INTERVENTIONS for each of the three clinical issues e.g., Encourage deep breathing exercises hourly 3. Explain RATIONALES for each nursing intervention. Rationales justify your interventions and are referenced. Suggestion: Intervention: Encourage deep breathing exercises including use of the spirometry, hourly; Rationale: Smith (2019) surmises that this promotes normal lung expansion increases oxygen levels, and is useful in preventing pneumonia and atelectasis Part B: Discharge planning (600 words) 1. Plan and prioritise discharge advice for Ben 2. In the discharge plan, consider the appropriate post-operative education for Ben post-surgical care. Provide a concise discharge plan that includes education around medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification. 3. Refrain from merely providing generic information. Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan. Provide a CONCLUSION (approximately 100 words) Your conclusion succinctly summarises the main points of your assignment, not an opportunity to introduce added information. Assignment Tips ASSIGNMENT DETAILS Introduction Provide an overview of the structure of the assignment. Provide a brief overview of how you will approach each section. Outline examples in your essay that will be used to respond to the assignment question. Do not restate the case Part A: Identifying clinical issues, proposing nursing interventions and rationales Clinical issues • Consider pathophysiology, Ben’s co-morbidities, current medications, surgery, and response to general anaesthesia • Consider the relevant assessment data you have been given in the case and other assessment data you will need to collect to care for Ben • Choose three (3) prioritised actual or potential clinical issues. Be mindful of the 24-hour post-operative period • It is expected that the information in this section will be referenced (Academic sources 4-6 would be reasonable for this section) Prioritised interventions supported with researched rationales • Evidenced based nursing interventions and rationales should relate to pathophysiological processes and aim to improve clinical outcomes. • The rationales support your interventions and justify why you have prioritised clinical issues. Rationales need to be referenced. (Academic sources 4-6 would be reasonable for this section Part B - Discharge planning • Consider both physiological and psychosocial aspects in discharge planning. (3-5 academic sources are expected for this section) Conclusion • Provide a critical review and summarise the main findings of the assignment. Length Markable word limit of 2000 words. This limit does not include the reference list but does include all in-text citations and headings. There is no minimum word limit for this assignment but if you write less than 1000 words, it may be difficult to meet the marking criteria. Marks out of: Weighting: A total of 70 marks = 40% (refer to Marking Rubric) APA 7 formatting, no dot points, no bullets _____________________ Study Bay Notes: Nursing the gastrointestinal surgical patient Gastrointestinal (GI) surgery is a broad term that encompasses various procedures performed on the digestive tract, such as gastrectomy, colectomy, ileostomy, or bowel resection. These surgeries can be done for different reasons, such as cancer, ulcerative colitis, Crohn's disease, diverticulitis, or bowel obstruction. GI surgery can have significant impacts on the patient's physical and psychological well-being, as well as their nutritional status and quality of life. Therefore, nurses play a vital role in providing holistic and evidence-based care for GI surgical patients throughout the perioperative period. Pathophysiology and pharmacotherapy of GI surgery The pathophysiology of GI surgery depends on the type and extent of the procedure, as well as the underlying condition that necessitated it. Generally, GI surgery involves removing or bypassing a part of the digestive tract, which can alter the normal anatomy and physiology of digestion and absorption. This can lead to complications such as malnutrition, dehydration, electrolyte imbalance, dumping syndrome, bacterial overgrowth, or short bowel syndrome. Moreover, GI surgery can cause inflammation, infection, bleeding, or leakage at the surgical site, which can impair wound healing and increase the risk of sepsis or peritonitis. Additionally, GI surgery can affect the motility and function of the remaining bowel segments, resulting in constipation, diarrhoea, ileus, or bowel obstruction. The pharmacotherapy of GI surgery aims to prevent or treat these complications, as well as to manage pain and discomfort for the patient. The choice and route of medication depend on the patient's condition, surgical procedure, and postoperative status. Some of the common medications used for GI surgical patients include: - Antibiotics: to prevent or treat wound infections or bacterial overgrowth. - Analgesics: to relieve pain and inflammation. Opioids are often used for severe pain but can cause constipation or ileus. Non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated for patients with ulcers or bleeding disorders. - Antiemetics: to prevent or treat nausea and vomiting. - Proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs): to reduce gastric acid secretion and prevent ulcers or gastritis. - Laxatives or stool softeners: to prevent or treat constipation. - Antidiarrhoeals: to prevent or treat diarrhoea. - Oral rehydration solutions (ORS) or intravenous fluids: to prevent or treat dehydration and electrolyte imbalance. - Vitamins and minerals: to supplement nutritional deficiencies caused by malabsorption. Non-pharmacological management of GI surgery Non-pharmacological management of GI surgery involves providing supportive care and education for the patient and their family. Some of the key aspects of non-pharmacological management include: - Nutrition: GI surgery can affect the patient's ability to eat and digest food. Therefore, nurses need to assess the patient's nutritional status and provide appropriate dietary advice and interventions. Depending on the type of surgery and the patient's tolerance, oral intake may be resumed gradually from clear fluids to solid foods. The patient may need to follow a modified diet that is low in fat, sugar, fibre, lactose, or gluten to avoid dumping syndrome or diarrhoea. The patient may also need to eat small frequent meals and chew food well to facilitate digestion and absorption. In some cases, the patient may require enteral or parenteral nutrition to meet their nutritional needs. - Wound care: Nurses need to monitor the surgical site for signs of infection, bleeding, or leakage. They also need to perform wound dressing changes and teach the patient how to care for their wound at home. If the patient has a stoma (an artificial opening in the abdomen), nurses need to provide stoma care and education on how to use and maintain ostomy appliances. - Mobility: Nurses need to encourage early mobilization and ambulation for the patient after surgery to prevent complications such as deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, or atelectasis. They also need to Help the patient with activities of daily living (ADLs) and provide appropriate aids or devices if needed. - Bowel function: Nurses need to assess the patient's bowel function and record their bowel movements and flatus. They also need to educate the patient on how to prevent or manage constipation or diarrhoea by using medications, fluids, fibre, or exercise. Nurses need to be aware of the signs and symptoms of ileus or bowel obstruction and report them promptly if they occur. - Psychological support: GI surgery can have a negative impact on the patient's self-image, body image, sexuality, and social life. Nurses need to provide emotional support and counselling for the patient and their family and address any concerns or fears they may have. Nurses also need to refer the patient to appropriate resources or services if they need further help or support. Principles of professional nursing practice for GI surgical patients The principles of professional nursing practice for GI surgical patients are based on the Australian Nursing and Midwifery Federation (ANMF) Standards for Practice for Registered Nurses (2016). These standards outline the expectations and responsibilities of nurses in providing safe, competent, ethical, and holistic care for their patients. The standards are: - Thinks critically and analyses nursing practice. - Engages in therapeutic and professional relationships. - Maintains the capability for practice. - Comprehensively conducts assessments. - Develops a plan for nursing practice. - Provides safe, appropriate, and responsive quality nursing practice. - Evaluates outcomes to inform nursing practice. These standards can be applied to the care of GI surgical patients by: - Using evidence-based knowledge and skills to assess, plan, implement, and evaluate the care of GI surgical patients. - Collaborating and communicating effectively with the patient, their family, and the multidisciplinary team to ensure continuity and quality of care. - Respecting the patient's rights, preferences, values, and beliefs and involving them in decision-making and goal-setting. - Advocating for the patient's best interests and protecting them from harm or abuse. - Maintaining professional boundaries and confidentiality and adhering to ethical and legal principles. - Engaging in reflective practice and lifelong learning to enhance competence and performance. - Participating in quality improvement activities and research to improve nursing practice and patient outcomes. References ANMF. (2016). ANMF standards for practice for registered nurses. https://anmf.org.au/documents/ANMF_Standards_for_Practice.pdf Davies, A., & Leach, H. (2008). Nursing care of gastrointestinal (GI) patients. In D. Reed & S. Mallett (Eds.), Oxford handbook of gastrointestinal nursing (pp. 9–30). Oxford University Press. Nurseslabs. (2020). 2 Subtotal gastrectomy nursing care plan. https://nurseslabs.com/subtotal-gastrectomy-nursing-care-plan/ RCH. (2019). Clinical guidelines (nursing): Post-operative bowel management. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Post-Operative_Bowel_Management/

Published by

Essay Pro

View all posts