Nursing Management Case Study Kelly Post-Operatively

Postoperative care is the last part of the perioperative experience patients requiring surgery will experience. Postoperative involves the rigorous assessment of patient vital signs, pain scale and effectiveness of pain control, maintenance of adequate fluid, assessment of and education regarding nutrition, the assistance of excretion processes and education. Patient progress is documented by nursing and medical observations in the patient care plan. This essay will focus on the Septoplasty and Ethmoidectomy postoperative care of a patient and focus on the nursing process with three prioritised nursing diagnoses and their management. Septoplasty is a surgical procedure reshaping or correcting the septum of the nose, the nasal septum is the

VASNHS Surgical Specialty Outpatient department has a designated pre-operative management unit that oversees the patients undergoing surgery. The predicaments stem from various guidelines or protocol originating from numerous surgeons and clinics. At present, the pre-operative nurses abide simple pre-op instructions (NPO protocol, medications, what to bring, during the surgery, transportation, cancellation instructions) for the entire Surgical Specialty Outpatient department. Surgical procedures are being canceled due to lack of communications and cancelations of patients prior to surgery date.

At first, the surgery seemed to be successful. But several hours later, the patient’s condition began to deteriorate, and it continued to worsen over the next few days.

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton

The prevalence of perioperative anxiety in clients has been estimated as ranging from 11% to 80% (Akkamahadevi & Subramanian 2016). Concern over a clearly high number of anxious people awaiting their surgical procedures has prompted examination of how perioperative nurses might reduce these rates of anxiety.

The purpose of the first part of this paper is to overview of the postoperative care plan within first 24 hours with respect to elucidate relevant assessment, potential clinical problems and the rationales of nursing interventions that can be presented based on the patient’s case. (Please refer to page 6 to 7 of this assignment.) Second section of this paper will discuss about the possible surgical complications associated with smoking and the co-morbidity of pre-existing medical condition of the patient, which is a dysfunction of cardiovascular system, in relation to having a general anaesthesia within the 24 hour period of post operation phase. Lastly, the third part will outline the discharge plan of the patient, focusing on the ongoing

Surgery always comes with a number of risks and when you compound that with any pre-existing medical conditions it often creates a host of post-operative complications that the body has to now try and compensate for. When this stress response kicks in its main goal is to preserve the body’s vital resources to ultimately keep the individual alive by regulating blood pressure, heart rate, electrolytes, oxygen output, respiratory rate, blood volume distribution, coagulation, blood sugar and urine output. Mr Jensen was diagnosed with Diabetes Melitus (Type II) 2 years ago and a history of Hypertension which would create extra burden to regulate the above mentioned vital resources which could potentially be life threatening. A major factor that

Mrs. D is a 3 week post colectomy patient that has been readmitted to the hospital with severe dehydration. She has been struggling with proper nutrition and ostomy care since her discharge post-surgery. Our goal with Mrs. D should be to rehydrate her and provide her with patient education on the importance of proper nutrition and on ostomy care. After she has been rehydrated with intravenous fluids and proper nutrition she could benefit from possibly skilled nursing facility placement for continued education for proper nutrition and ostomy care depending of her activity level and if she can tolerate making her own meals or do her own ostomy care she may could benefit from home health care

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.

Background and Rationale: Currently, postoperative pulmonary complications “account for about 25% of deaths occurring within 6 days of surgery,” (Yoder, M 2015). Post-operative pulmonary complications (PPCs) are of major concern due to the increased length of hospital stays and high rates of occurrence and death as a result. Those at greater risk of developing a pulmonary complication include preexisting lung disease, medical comorbidities, poor nutritional status, overall poor health, and in those who smoke. (Yoder, M, 2015.) The type of surgery the patient is having also affects the risk. Complications include, but are not limited to, pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation. The development of such complications negatively affects the expected outcomes for patients. “The basic mechanism of PPCs is a lack of lung inflation that occurs because of a change in breathing to a shallow, monotonous breathing pattern without periodic sighs, prolonged recumbent positioning and temporary diaphragmatic dysfunction. Mucociliary clearance along with the decreased cough effectiveness, increases risks associated with retained pulmonary secretions, “ (Overend, T., Anderson, C., Lucy, S., Bhatia, C., Jonsson, B., & Timmermans, C., 2001). Currently,

On preoperative examination, the patient complained of respiratory difficulty, on a nasal catheter with O2 therapy and both lungs had diminished air entry. Baseline heart rate and blood pressure were 80 beats/min and 250/115 mmHg respectively. Also, Physical examination of this

Nurses care for patients who undergo emergent and preplanned surgeries. Nurses prepare their patients prior to surgery by educating them what the surgery is, what to expect during surgery and the outcome of the surgery. Preoperative anxiety is a result of patient’s anticipation to the surgery manifested by psychological and physiological indicators (Alanazi, 2014). Review of literature shows that preoperative anxiety is a common phenomenon that nurses encounter in practice as they care for patients undergoing surgery (Yilmaz, Sezer, Gurler, & Bekar, 2011). Preoperative anxiety can increase need for anesthesia, pain patient experiences after surgery therefore increases need for pain medication, increase length of recovery time, and delay of discharge (Alanazi, 2014). With the effects of preoperative in mind it is important to understand what preoperative anxiety is and what the symptoms are. The domains of nursing care will be used to explain preoperative anxiety as a nursing phenomenon. American Nurses Association (ANA) Social Policy Statement and ANA scope and standards of care will be used to provide nursing interventions to help reduce anxiety. Nursing care and practice can help patients reduce and manage patient anxiety. The role of Family Nurse Practitioner (FNP) will be discussed in helping reduce preoperative anxiety.

Early ambulation after surgery or any length of stay in a hospital has shown improved patient outcomes. Nurses ' play a huge role in patient 's recoveries. Nurse roles can also affect attitudes and perceptions of patient care. Attitudes by nurses can be affected by staffing, time management, and patient loads. The higher acuity patients that a nurse is caring for with inadequate time or support staff can create a stressful environment and result in a possible negative attitude towards patient care.

This textbook focuses on medical-surgical nursing which covers basic topics such as concepts of nursing to more complex issues such as fluid balances within the body, oxygenation and blood perfusion, and breathing or respiratory issues. The purpose of a medical-surgical textbook for nursing students is to give them a foundation to build their future knowledge upon. This type of textbook will teach them the very basic concepts a nurse needs to know and later in their schooling they will learn more in depth illnesses, treatments, and procedures.

“Thick red scars called hypertrophic scars may appear” after surgery (source 7 page 2). In breast augmentation, “the number one complaint is capsular contracture, a type of scarring around the breast implant itself. In many cases, it becomes painful because the scarring makes the breast feel hard (Stuart and Kotler 2). The most common risks in surgery is paralysis (Serano 2). The “anesthesia and sedation can cause paralysis” after the procedure is completed (source 7 pg. 1). Revision surgeries are more prevalent when someone undergoes nasal surgery. Facial surgeons mostly see “people coming for a revision when a nose is overdone and looks too pinched. It is usually because the first surgeon took out too much tissue” (Stuart and Kotler 2). “The thing many nasal surgeons see over and over is a healed nose with some grooves, depressions, and moguls that show up on the outside” (Stuart and Kotler 2).