Peri-Operative Nursing and Crohn's Disease

The assignment provides an overview of peri-operative nursing responsibilities, including the application of critical thinking skills and physical assessment before administering pethidine. It also covers legal nursing responsibilities associated with pethidine administration, such as engaging in therapeutic relationships with patients and respecting their autonomy. Additionally, the document discusses Crohn's disease management, including the definition of the condition, its effects on the gut microbiota, and the importance of maintaining electrolyte balance during surgical resection. The assignment also touches on the administration of Hartman's solution to maintain electrolyte balance.

Running head: PERI-OPERATIVE NURSING
Peri-operative Nursing
Name of the Student
Name of the University
Author Note

1PERI-OPERATIVE NURSING
Answer 1
Nursing responsibility before administration of pethidine includes application of the
critical thinking skills in order to analyse the best available evidence behind the application of
pethidine in relation to pain management. It is also the duty of the nurse to conduct the
physical assessment in a comprehensive manner in order to fetch accurate data or information
going in favour of the administration of pethidine. Physical assessment should be done via
asking Jordan about the severity of the pain.
Legal nursing responsibilities associated with administration of pethidine include
engaging in therapeutic and professional relationship with the Jordan. This can be done via
recognizing that patient (Jordan) is an expert in the experience of his life and thus he has
every right to provide opinion in favour of his treatment. Thus the ethical principle of
autonomy not only deals with allowing the patients to take their own decisions. Nursing or
other healthcare professionals have an obligation to frame conditions required for the
autonomous choice for patients. Thus before administration of pethidine, it is the duty of the
nurse to example why he is given pethidine, what is the function and side-effects of the
medicine and whether Jordan is willing to take the same in order to manage his pain. It is also
the legal rights of the nurse to provide safe and competent nursing care to Jordan and this
falls under the ethical principle of non-malfeasance. So the attending nurse should check the
valid medical order charted by the medical office before administering the medicine. The
drug should be cross-checked with two registered nurses and document the same in the drug
book and prescription chart of Jordan.
Nursing responsibility after administration of pethidine includes evaluation of the
outcome of the medicine. Since pethidine is mostly administered for pain management
evaluation of outcome include assessment of the pain and its associated chronicity via

2PERI-OPERATIVE NURSING
constant monitoring of Jordan’s condition. This will be followed by communication of
further priorities outcomes and associated goals in relation to Jordan.
Answer 2
Crohn’s disease is defined as a relapsing systemic inflammatory disease. It mainly
affects the entire gastro-intestinal tract and is the part of the inflammatory bowel disease
(IBD). Crohn’s disease leads to the modification of the commensal gut microbiota. The first
line of defence of mucosal immune system is polarised single layer of epithelial cells that
remain covered by mucus biofilm. Mucus biofilm is a form of goblet cells with the
interspersed microbiota. In Crohn’s disease, the equilibrium of the gut microbiota is
disrupted. This down regulates mucin gene synthesis in the terminal region of the inflamed
ileum. Lack of mucin gene blocks the formation of mucus biofilm leading to insufficient
mucin cover. Thinning of mucus bioflim causes perforation of the intestinal wall leading
Jordan to vomit. Vomiting in turn leads to loss of appetite which ultimately led Jordan to
suffer from significant weight loss.
Narrowing of the ileum in the segmental areas is known as ileal stricture. Generally
rigid thickening along with fibrosis over the wall of the ileum leads to this obstruction.
Normally, intestine propels the contents of the lumen when the lumen is fairly wide enough.
However, Crohn’s disease is associated with intestinal inflammation which is followed by the
activation of smooth muscle cells of the intestine. This is followed by cascade of events,
leading to the secretion of interleukin-1β. Interleukin-1β activates collagen at the site of the
injury. Deposition of the collagen in the ileum causes thickening of the intestinal muscle and
this is responsible for the formation of Jordan’s ileal stricture.

3PERI-OPERATIVE NURSING
Answer 3
The intravenous fluid which is ordered for Jordon is Hartman’s solution. Active
ingredient present in Hartmann’s solution is sodium chloride, sodium lactate, calcium
chloride and potassium chloride.
In order maintain the electrolyte balance Jordan’s body during the surgical resection
of the affected ileum, intravenous of administration of Hartman’s solution is essential.
Sodium is the main cation of Hartmann’s solution and its act in maintaining the electrolyte
balance, water of distribution and osmotic pressure of the body fluid. Chloride is the major
extracellular anion which helps in maintaining the acid-base balance of the body via
stabilizing the electro-dynamic characteristics and isotonicity of the cells. Potassium ion is
another cation in the Hartmann’s solution which helps in marinating body fluid composition
and electrolyte balance via participating in protein synthesis, carbohydrate utilization and
active regulation of muscle contraction and nerve conduction which is important at the time
of operation.