Acute Nursing Illness Assignment

Running head: ACUTE NURSING ILLNESS
Acute Nursing Illness
Name of the student
University name
Authors’ note

1
ACUTE NURSING ILLNESS
Table of Contents
Evaluation of oxygenation, ventilation and acid base balance...............................................2
Encouraging fluid intake........................................................................................................3
Intervention 3:........................................................................................................................3
Oxygen therapy..........................................................................................................................3
Conclusion..............................................................................................................................4
References..............................................................................................................................5

2
ACUTE NURSING ILLNESS
Evaluation of oxygenation, ventilation and acid base balance
The patient here was diagnosed with a condition of cholecystitis and had to undergo
an immediate surgery for that. The injury from the surgery led to the shunted blood flow
through the vasodilated tissues after surgery. Additionally, the patient had a past history of
smoking, which resulted in coughing in the patient. Therefore, management of oxygen and
ventilation post surgery served as an important parameter. As mentioned by Schietroma,
Colozzi, Pessia, Carlei & Amicucci (2017), patient with smoking history often require higher
rates of post-operative ventilator support compared to the ones who do not smoke. This is
because too much smoking affected the contracting power of the alveoli present in the lungs,
which affected the inspiration/ expiration capacity of the patient. The smoking addition
resulted in increased acidity, which further worsened the conditions of gastric oesophageal
reflux disorder in the patient. The symptom of GERD is often expressed in the form of
abdominal bloating, coughing sore throat etc.
In this context, the patient Mr. X had been a chain smoker and had difficulty in
breathing post the cholecystectomy. The doctor and the nursing professional attending the
patient had to ensure that the patient is hooked off the ventilator only on restoration of normal
breathing capacity. For sufficient oxygenation an endotracheal tube could be placed in the
mouth or nose and threaded down the airway (Miguel-Montanes et al., 2015). As suggested
by Zhou, Chen, Zhang, Li & Guo (2017), the normal breathing capacity of a person is often
altered post trauma. Additionally, the deposition of mucous post –surgical injury made
breathing more difficulty in the patient. Hence, the ventilation needs to be continued till the
patient is able to breathe on his own or the partial pressure of oxygen is restored.

3
ACUTE NURSING ILLNESS
Encouraging fluid intake
Fluid intake is one of the most important criteria post cholecystectomy. It is
prescribed that a patient is advised to take sufficient fluids post – cholecystectomy unless the
doctors advise not to do so (Gomez & Cox, 2018). The patient needs to be put on clear liquid
diets to prevent nausea, vomiting and constipation. Therefore, suggesting the patient Mr. X to
intake more of soups, carbonated beverages which could be followed upon by regular low
fat diet. Additionally, the patient needs to be encouraged to eat lots of whole grains, fruits and
green leafy vegetable. The intake of fluid help in restoration of the normal metabolic
capacity of the body along with helping the patient in reviving normal urinating capacity ,
which is a vital sign to be monitored post surgery (Pan et al., 2018).
Intervention 3:
Oxygen therapy
The upper abdomen surgery is followed by impairment of arterial oxygenation. This
could be attributed to two main causes mainly- shunting of blood flow thorough the
collapsed lung tissues areas, increases in ventilation to perfusion ration across the lungs. The
arterial oxygen tension s could be compared with other forms of lung disease in patients.
For the purpose of reducing this distress oxygen therapy was suggested in the patient.
The oxygen therapy could be delivered in two specific forms such as – using Continuous
Positive Airway Pressure (CPAP) of 10 cm water and Fio2 of 0.5 using a venture mask of
Fio2 0.5, where Fio2 refers to fraction of inspired oxygen. As mentioned by Kim, You, Kim &
Hong (2017), the oxygen therapy using combinatorial approach where both CPAP and Fio2
were seen to produce better results in the patient after cholecystectomy surgery. The CPAP
pathway has been seen to be safe and effective in improving gaseous exchange within the
patients. However, as suggested by de’Angelis et al. (2017), the patient should be checked

4
ACUTE NURSING ILLNESS
for intolerance which may results in reintubation to be done within the patient. The chances
of post-operative hypoxemia range somewhere between 6-60% in patients with upper
abdomen surgery (Pan et al., 2018). Therefore, the oxygen therapy helps in the restoration of
normal breathing capacity in the patient. However, prolonged CPAP therapy may result in
suffocation and development of intolerance.
However, in case the patient is a chain smoker and suffers from respiratory distress
the patient needs to be put on a prolonged respiratory therapy. However, in case intolerance
towards CPAP develops the patient could be shifted to Fio2 therapy.
Conclusion
The current assignment discusses upon the nursing interventions and strategies which
could be applied in dealing with a patient, which has undergone cholecytectomy. In the
study, emphasis has been out upon the oxygenation and airway pathway. The oxygen distress
over here could arise owing to a number of conditions such as post –operative trauma, lesions
at the surgical wound sites along with thrust of blood flow through the collapsed alveoli of
the lungs, which are unable to facilitate the gaseous exchange. It may further develop the
arterial oxygen tension leading to breathing difficulties in the patient. Therefore, proper
follow up along with provision of sufficient amount of fluids to the patient as a part of the
post –operative care can help in restoration of normal electrolyte balance of the body.

5
ACUTE NURSING ILLNESS
References
de’Angelis, N., Abdalla, S., Carra, M. C., Lizzi, V., Martínez-Pérez, A., Habibi, A., ... &
Brunetti, F. (2017). Low-impact laparoscopic cholecystectomy is associated with
decreased postoperative morbidity in patients with sickle cell disease. Surgical
endoscopy, 1-12. Retrieved from: https://link.springer.com/article/10.1007/s00464-
017-5925-y
Gomez, D., & Cox, M. R. (2018). Laparoscopic Transcystic Stenting and Postoperative
ERCP for the Management of Common Bile Duct Stones at Laparoscopic
Cholecystectomy. Annals of surgery, 267(5), e86-e88. doi:
10.1097/SLA.0000000000002426
Kim, E. Y., You, Y. K., Kim, D. G., & Hong, T. H. (2017). The Simple and
Multidimensional Method of Pain Reduction After Laparoscopic Cholecystectomy: A
Randomized Prospective Controlled Trial. Journal of Laparoendoscopic & Advanced
Surgical Techniques, 27(3), 229-233. Retrieved from:
https://doi.org/10.1089/lap.2016.0326
Miguel-Montanes, R., Hajage, D., Messika, J., Bertrand, F., Gaudry, S., Rafat, C., ... &
Dreyfuss, D. (2015). Use of high-flow nasal cannula oxygen therapy to prevent
desaturation during tracheal intubation of intensive care patients with mild-to-
moderate hypoxemia. Critical care medicine, 43(3), 574-583. doi:
10.1097/CCM.0000000000000743
Pan, L., Chen, M., Ji, L., Zheng, L., Yan, P., Fang, J., ... & Cai, X. (2018). The Safety and
Efficacy of Laparoscopic Common Bile Duct Exploration Combined with

6
ACUTE NURSING ILLNESS
Cholecystectomy for the Management of Cholecysto-choledocholithiasis: An Up-to-
date Meta-analysis. Annals of surgery,55-75. DOI: 10.1097/SLA.0000000000002731
Schietroma, M., Colozzi, S., Pessia, B., Carlei, F., & Amicucci, G. (2017). The Effects of
High-Concentration Oxygen on Inflammatory Markers in Laparoscopic
Cholecystectomy: A Randomized Controlled Trial. Surgical Laparoscopy Endoscopy
& Percutaneous Techniques, 27(2), 83-89. doi: 10.1097/SLE.0000000000000326
Zhou, Y., Chen, H., Zhang, H., Li, M., & Guo, J. (2017). Anesthesia for a Patient with Severe
Pulmonary Hypertension Undergoing Laparoscopic Cholecystectomy: A Case
Report. J Pulm Respir Med, 7(403), 2. DOI: 10.4172/2161-105X.1000403

7
ACUTE NURSING ILLNESS