Executive Summary
This report is based on a case study of Mrs Eleanor, who has passed through the hemicolectomy and midline incision surgery. According to her past life history, due to the reason of several health complications like hypertension, high blood pressure, and hypercholesterolemia, she may experience various co-morbid conditions during the 24-hour post-operative stage. Therefore, in order to reduce the level of adverse conditions, assessment is required for identifying the clinical complications, like diarrhoea, septicaemia, and constipation. Nursing intervention planning is also required for reducing the occurrence percentage. Besides this, a complete discharge planning can be performed for delivering the optimum health care level.
Table of Contents
Plan A: Nursing Intervention Plan. 4
Plan B: Analysis of identified clinical issues. 8
Co-morbidity of Mrs Eleanor according to her health condition. 8
Potential clinical complications. 8
Nursing interventions for clinical complications. 9
Analysis of case study with the interventions. 11
Part C: Discharge Planning. 11
Acute care patients mostly require excessive support during the pre-operative and post-operative stage apart from the time of surgeries, for coping with their acute health conditions raised by their acute diseases. In order to assist the acute care patients, nurses need to play the most considerable role for managing their health requirements and providing the opportunity of quick recovery. Besides their physical status, acute care nurses also need to focus on their mental stability as most of the acute care patients undergo a phase of mental trauma after completion of surgical processes. This assignment highlights the potential issues after hemicolectomy surgery, process of assessment, nursing role in intervention planning, rationale behind intervention, and a brief discussion plan.
Plan A: Nursing Intervention Plan
Through analysing the given data and information about the pre-operative history and postoperative condition of Eleanor, nursing intervention plan can be developed by focusing on the associated risk factors and their likelihoods. According to the statement of Santana et al. (2018), nursing intervention plans can support the nurses in following a regulatory process for delivering best care to the acute care patients.
Table 1: Nursing Intervention Plan
(Source: Created by author)
Plan B: Analysis of identified clinical issues
Co-morbidity of Mrs Eleanor according to her health condition
Based on the medical definition, the term ‘co-morbidity’ can be defined as the presence of more than one additional disease, which can be co-occurred with a primary health-issue (Avenevoli et al. 2015). For example, patients having Major Depressive Disorder and Social Anxiety Disorder can be termed as co-morbid, due to the presence of both depression and anxiety. Therefore, through analysing the past life history of Eleanor, highly co-morbid situation is present in this case. For example, Mrs Eleanor’s past medication history includes myocardial infarction, hypercholesterolemia, hypertension, asthma, and bronchitis. This high co-morbid condition of her health is related with her 40 years habit of smoking.
As opined by Conway et al. (2016), smoking can cause lung cancer, asthma, bronchitis, and many other respiratory problems. Besides this, the smoking habit, higher cholesterol level, and hypertension level of Eleanor is also related with the myocardial infarction, due to which she has experienced with left coronary artery stenting. Apart from this, as her father had died due to the reason of bowel cancer, therefore an increased risk related with bowel cancer is present as a genetic issue. Therefore, based on this information, it can be stated that the process of general anaesthesia can impose a significant threat to the condition of Mrs Eleanor, due to the reason of affecting heart, increasing blood pressure, and smoking habits.
Potential clinical complications
According to the past and present health issues of Eleanor, different types of co-morbid complication can occur during the 24hours post-operative surgical process. According to the statement of Chan et al. (2015), the 24-hour postoperative time is critical for patients, as most of the after surgical impacts start at this time. In this case, due to the reason of bowel surgery by hemicolectomy and midline incision, the two related co-morbidities are diarrhoea and septicaemia.
Diarrhoea- After any types of surgery in the bowel area, diarrhoea is one of the most common issues during the initiation of postoperative period. As opined by Watkins (2015), due to the reason of colon shortening, stool can pass with a faster speed. This complication is not life-threatening, as it reduces after 6-8 week and colon can begin normal functioning. However, in case of long piece removal, faster passing of stool may become chronic side effect.
Septicaemia- Septicaemia is a disease, in which the entire blood circulation system of an individual gets affected due to the reason of bacterial contamination. Surgeries like hemicolectomy, appendectomy, cataract surgery, caesarean surgery, and many others, have a higher risk of septicaemia. In this case, septicaemia can occur due to the reason of skin impairment at the surrounded area of surgery. During the postoperative time, skins become excessively sensitive, due to which bacterial infection can easily affect the area. After infection, bacteria can enter into the bloodstream and spread throughout the body. As a result, patients sometimes undergo through a phase of multi-organ failure, and at last death (Saul, 2018).
The above mentioned clinical complication are required to manage by implementing proper nursing intervention planning, which can be as follows
Table 2: Nursing Care intervention plan
(Source: Created by Author)
Analysis of case study with the interventions
Based on the past medical history of Eleanor, it can be stated that she has a higher chance of septic shock as well as diarrhoea, due to the reason of various pre-operative complications. According to the previous history of Mrs Eleanor, since she had a 40-year habit of daily smoking, therefore, increasing heart risk is present in her case. Besides this, due to the reason of bowel surgery, diarrhoea and septic shock can be occurred. Therefore, focusing on these risks, the interventions mentioned above are required to include. As mentioned by (), proper diet chart is essential for the patients, like Eleanor, in order to avoid the issue of diarrhoea. Besides this, it is also required to measure the nature of stool frequency of output, weight gaining, or losing pattern, and many other factors that are associated with this disease. Besides this, Woodfield, Jamil & Sagar (2016) has mentioned that the risk of septicaemia including skin irritation, impairment and infection can be reduce through blood testing and liver functionality testing. It can be avoided by increasing regular dressing and cleaning procedures.
Since management of post-operative condition is critical, therefore, it is required to develop a discharge planning, for supporting the patients in returning to their normal lives. This discharge planning is mainly required during the residential care setups. In case of Mrs Eleanor, the discharge planning may be as follows-
Table 3: Discharge planning for Mrs Eleanor
(Source: Created by Author)
Therefore, based on the entire discussion, it can be concluded that it is necessary to focus on the co-morbid condition after certain types of internal surgical procedures. Besides this, assessment of present health condition of Mrs Eleanor is necessary for maintaining her health and safety level.
Reference List
Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the National Comorbidity Survey–Adolescent Supplement: prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 37-44. Retrieved on 1 September 2018. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408277/
Chan, S. S., Leung, D. Y., Leung, A. Y., Lam, C., Hung, I., Chu, D., ... & Lam, T. H. (2015). A nurse-delivered brief health education intervention to improve pneumococcal vaccination rate among older patients with chronic diseases: A cluster randomized controlled trial. International journal of nursing studies, 52(1), 317-324. Retrieved on 8 September 2018. Retrieved from https://www.sciencedirect.com/science/article/pii/S0020748914001655
Colombara, F., Martinato, M., Girardin, G., & Gregori, D. (2015). Higher levels of knowledge reduce health care costs in patients with inflammatory bowel disease. Inflammatory bowel diseases, 21(3), 615-622. Retrieved on 5 September 2018. Retrieved from https://academic.oup.com/ibdjournal/article-abstract/21/3/615/4602929
Conway, K. P., Swendsen, J., Husky, M. M., He, J. P., & Merikangas, K. R. (2016). Association of lifetime mental disorders and subsequent alcohol and illicit drug use: results from the National Comorbidity Survey–Adolescent Supplement. Journal of the American Academy of Child & Adolescent Psychiatry, 55(4), 280-288. Retrieved on 8 September 2018. Retrieved from https://scholar.google.co.in/citations?user=4_uu7t0AAAAJ&hl=en&oi=sra
DeHaas, D., Aufderheide, S., Gano, J., Weigandt, J., Ries, J., & Faust, B. (2016). Colorectal surgical site infection reduction strategies. The American Journal of Surgery, 212(1), 175-177. Retrieved on 1 September 2018. Retrieved from https://www.sciencedirect.com/science/article/pii/S0002961016302069
Ellis, C. N. (2017). Discharge criteria after colon resection: Is return of bowel function necessary?. The American Journal of Surgery, 213(3), 544-547. Retrieved on 2 September 2018. Retrieved from https://www.sciencedirect.com/science/article/pii/S0002961016308212
Intestinal Atony. (2018). Retrieved on 2 September 2018. Retrieved from http://keywordsuggest.org/gallery/479948.html
Johnson, M. P., Kim, S. J., Langstraat, C. L., Jain, S., Habermann, E. B., Wentink, J. E., ... & Cima, R. R. (2016). Using bundled interventions to reduce surgical site infection after major gynecologic cancer surgery. Obstetrics & Gynecology, 127(6), 1135-1144. Retrieved on 1 September 2018. Retrieved from https://www.wesleyobgyn.com/pdf/education/2016.08.17_Using_Bundled_Interventions_to_Reduce_Surgical%20Site%20Infection.pdf
Kelly, K. N., Iannuzzi, J. C., Aquina, C. T., Probst, C. P., Noyes, K., Monson, J. R., & Fleming, F. J. (2015). Timing of discharge: a key to understanding the reason for readmission after colorectal surgery. Journal of Gastrointestinal Surgery, 19(3), 418-428. Retrieved on 6 September 2018. Retrieved from https://link.springer.com/article/10.1007/s11605-014-2718-7
McNutt, M. K., Chinapuvvula, N. R., Beckmann, N. M., Camp, E. A., Pommerening, M. J., Laney, R. W., ... & Wade, C. E. (2015). Early surgical intervention for blunt bowel injury: the Bowel Injury Prediction Score (BIPS). Journal of Trauma and Acute Care Surgery, 78(1), 105-111. Retrieved on 2 September 2018. Retrieved from https://journals.lww.com/jtrauma/Abstract/2015/01000/Early_surgical_intervention_for_blunt_bowel.14.aspx
Nunan, M., Horoto, W., Manea, T., Duncan, G., & Duke, T. (2017). Scaling up zinc treatment for childhood diarrhoea in the developing country setting: a before‐and after‐intervention study. Journal of Pharmacy Practice and Research, 47(1), 16-22. Retrieved on 1 September 2018. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/jppr.1197
Santana, R. F., Pereira, S. K., do Carmo, T. G., Freire, V. E. C. D. S., Soares, T. D. S., do Amaral, D. M., & Vaqueiro, R. D. (2018). Effectiveness of a telephone follow‐up nursing intervention in postsurgical patients. International journal of nursing practice, e12648. Retrieved on 4 September 2018. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijn.12648
Saul, A. (2018). How a nursing care plan can facilitate successful nursing of a pony with hyperlipaemia. Veterinary Nursing Journal, 33(2), 44-47. Retrieved on 3 September 2018. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/17415349.2017.1406831
Tebala, G. D., Keane, S., Osman, A., Ip, M., Khan, A. Q., & Perrone, L. (2016). Early Discharge After Colorectal Resection: The Positive Impact of an Enhanced Recovery Program on a Rural Colorectal Surgery Service. Surgical laparoscopy, endoscopy & percutaneous techniques, 26(6), e137-e144. Retrieved on 1 September 2018. Retrieved from https://www.ingentaconnect.com/content/wk/slept/2016/00000026/00000006/art00008
Trippia, C. H., Zomer, M. T., Terazaki, C. R., Martin, R. L., Ribeiro, R., & Kondo, W. (2016). Relevance of imaging examinations in the surgical planning of patients with bowel endometriosis. Clinical Medicine Insights: Reproductive Health, 10, CMRH-S29472. Retrieved on 1 September 2018. Retrieved from http://journals.sagepub.com/doi/full/10.4137/CMRH.S29472
Watkins, J. (2015). Meningitis and septicaemia: Complications and early response. British Journal of School Nursing, 10(10), 479-481. Retrieved on 1 September 2018. Retrieved from https://www.magonlinelibrary.com/doi/full/10.12968/bjsn.2015.10.10.479
Wick, E. C., Galante, D. J., Hobson, D. B., Benson, A. R., Lee, K. K., Berenholtz, S. M., ... & Wu, C. L. (2015). Organizational culture changes result in improvement in patient-centered outcomes: implementation of an integrated recovery pathway for surgical patients. Journal of the American College of Surgeons, 221(3), 669-677. Retrieved on 5 September 2018. Retrieved from https://www.sciencedirect.com/science/article/pii/S1072751515003701
Williams, A., Carter, J., Basu, P., Williams, M., & Edwards, P. (2017). Vitamin B12 Status Following a Right Hemicolectomy in Cancer: A Feasibility Study. Gastroenterology, 152(5), S1256-S1257. Retrieved on 1 September 2018. Retrieved from https://www.gastrojournal.org/article/S0016-5085(17)34183-5/abstract
Woodfield, J. C., Jamil, W., & Sagar, P. M. (2016). Incidence and significance of postoperative complications occurring between discharge and 30 days: a prospective cohort study. journal of surgical research, 206(1), 77-82. Retrieved on 2 September 2018. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022480416301949
Appendix
Figure 1: Hemicolectomy
(Source: Intestinal Atony, 2018)
