Patient Care: A Multidisciplinary Approach

This assignment discusses the multifaceted nature of patient care, emphasizing the need for a collaborative approach involving various healthcare professionals. It highlights the crucial roles of occupational therapists, social workers, and continence nurses in assisting patients like Janet, who requires wound management and rehabilitation after surgery. The document emphasizes the importance of understanding each professional's distinct role in ensuring coordinated and effective service delivery to patients.

BACHELOR OF NURSING ASSIGNMENT
[Author Name(s), First M. Last, Omit Titles and Degrees]
[Institutional Affiliation(s)]

Introduction
In the presented case study, Janet Jackson is diagnosed with uterine fibroids. Uterine
fibroids are growths of the uterus which are noncancerous and are usually experienced during the
childbearing years in the lifetime of a woman. A contraction of uterine fibroids increases the
chances of being infected by cancer of the uterus. Uterine fibroids vary in size from as small as
seedlings which are not noticeable by the naked eye to enormous masses which can lead to
permanent distortion and enlargement of the uterus. The disease can expand the uterus to the
extent of reaching the rib cage in extreme cases.
In as much as the exact cause or causes of uterine fibroids have not been proved yet,
scientific literature articles now contain information of significant size informative of the
epidemiology, hormonal aspects, genetics and molecular biology that can give enough
information regarding the causes. (Lee, 2012) These factors are divided into four categories
namely: effectors, predisposing, initiators, and promoters. Risk factors involve those conditions
that which have been generally identified through epidemiologic studies. Through such
knowledge, the etiology of the tumors responsible for uterine leiomyomas as well as the
preventive measures can be sought.
The initiators of uterine leiomyomas are known which more consideration given to
genetic aberrations. Despite the massive and in-depth investigations done, no clear information
can be presented regarding the primary or secondary characteristics of the changes of these genes
and their effect on promotion and/or initiation of uterine leiomyomas tumors. The ovarian
hormones estrogen and progesterone are found to be playing a significantly greater role in the

promotion of the growth of uterine leiomyomas tumors (McKay, 2012). This is a proof that has
been developed through clinical and laboratory experiments.
Risk factors associated with uterine leiomyomas
Age: An increase in age is a promoter of uterine leiomyomas especially during the
reproductive years of an individual. The increase is found, through studies, to be rapid among
women when they are in the age bracket of the forties (David R. Gambling, 2013). This increase
in prevalence can be associated with increased growth of already existing fibroids besides an
increased willingness of women in the later reproductive years to undergo gynecologic surgery.
Obesity: Studies that show a strong correlation between obesity and the prevalence of
uterine leiomyomas. The correlation is such that for every 10-kg increase in the weight of an
individual, there is an estimated 21% increase in the risk. This applied to the body mass index as
well. An increase in the adult BMI corresponds to an increased uterine leiomyomas risk besides
an associated risk of gain in weight. The correlation between uterine leiomyomas risk and
obesity can be linked to the hormonal factors which are associated with obesity. Still, other
pathologic factors can as well be involved in this course (Lee, 2012). The conversion of adrenal
androgens to estrogen with the help of adipose tissue is a major hormonal activity that increases
the risk factor for uterine leiomyomas (David R. Gambling, 2013). More unbound and
physiologically active estrogen is produced as a result of the hepatic production of sex hormones.
Menopause: The absence of stimulations of the hormones due to menopause increases the
risks of uterine leiomyomas (Lombardi, 2012). Uterine leiomyomas among postmenopausal

patients can be reduced through selection bias resulting from the tendency of a clinical approach
that is more conservative as well as nonsurgical.
Diet: An association has been found to exist between the consumption of ham and red
meat among them beef and the risk of the prevalence of uterine leiomyomas. On the contrary,
consumption of foods that are rich in green vegetable has a reverse effect and is found to reduce
the risk. Beef and ham are foods rich in fats which in turn increase the bioavailability of
progesterone and estrogen hormones (Goldman, 2015). Uterine leiomyomas known for being a
tumor which is responsive to hormones will then be promoted to grow and multiply.
Smoking: The correlation between smoking and uterine leiomyomas has been found to be
inverse with current smokers found to be having a 50% risk reduction as compared to past
smokers (Foundation, 2010). The more cigarettes individual smoke per day, the lower the risk of
the attack by uterine leiomyomas. This correlated has been attributed to the effect of smoking
which has been found to be anti-estrogenic. Still, there have been numerous derangements of
steroid metabolism which have been noticed in smokers (Foundation, 2010).
These metabolisms have been found to decrease the bioavailability at tissues that are
targeted by estrogen. At the same time, inhibition of aromatase by nicotine reduces the rate of
conversion of androgens to estrone. Other risk factors include menarche, parity, exercise, and use
of oral contraceptives etc. therefore, taking a back reflection of the case of Janet Jackson,
numerous factors can be alluded to the cause of her uterine fibroids condition such as smoking
and age (Tulandi, 2013). She is at her childbearing years hence the high risk of infection by
uterine fibroids.

A surgical operation is the most recommended treatment for uterine fibroids. It is
important to consider the size of the growth before the operation is carried out to ascertain the
extent of destruction and expansion the disease has done to the uterus (Goldman, 2015). The
treatment aims at reducing or completely relieving the patient of the pain she is experiencing. In
this case study, Janet undergoes a surgical operation so as to remove the growth in her uterus that
is causing her a lot of pain.
The most appropriate nursing management for postoperative hysterectomy is that which
aims at reducing the pain would be undergoing through (Stoelting, 2014). Being a surgical
operation, the process must be accompanied by pain that requires proper care and maintenance to
help the patient gain her self-worth even after undergoing the process. A surgical intervention is
the best option in handling the case of Janet as in will minimize pain as well as increasing the
quality of her life.
Upon completion of the surgical operation process, Janet is transferred to post anesthetic
recovery unit in which she undergoes close monitoring before she is further transferred to the
general ward. While in the PARU, anesthetist informs the nurse of the general conditions of the
patient, the type of anesthesia used for the operation and the operation type performed. The
anesthetist also informs the nurse of any complications experienced during the operation process.
In the comparison of Janet's baseline observation regarding the given case with the observations
taken before the surgical operation, her blood pressure when she was transferred to the PARU
was 90/50 mmHg which is a considerably low since the normal adult systolic blood pressure
should range between 100-120 mmHg with the diastolic pressure ranging 60-80 mm Hg. She
does not experience any pain and a normal body temperature. She experiences a high pulse rate

of 130 bpm above the normal rate which ranges from 60-100 beats a minute. This may be
attributed to anxiety and depression.
The lowered blood pressure of Janet can be attributed to the use of a general anesthesia
during the operation of Janet which caused a diminution of her sympathetic nervous system
culminating into considerable levels of blood loss. Janet Jackson was also found to be having a
respiratory rate higher than that of a normal adult. Her respiratory rate was 30 rpm which is way
above the normal range which is 12-20 rpm (McKay, 2012). A high respiratory rate shows
respiratory depression which is one of the side effects of uterine fibroids.
The PARU nurse is tasked with the role of conducting a detailed assessment of the
airway of the patient, the heart rate, temperature among other conditions of the body. The nurse
does this by assessing the health conditions of the patient at intervals of 15 minutes. The nurse
should conduct a cardiovascular assessment so as to monitor the heart rate and blood pressure.
Monitoring of the blood pressure levels and the heart rates is important for the case of Janet since
the hysterectomy operation led to side effects such as depression (Glaser, 2013). It would also be
important to monitor peripheral circulation in case the extent of the uterine fibroids attack was
extreme and reached the rib cage. This would have effects on level and degree of mobility. The
nurse should also be continuously conducting the orientation to the patient on strategies on how
to reduce depression and anxiety levels.
Plans of discharge usually begin as soon as the patient conditions begin to stabilize.
During discharge, the family and the patient may be stressed over fears of the patient not being
able to get back to normal. Upon the patient gaining stability, the family may be informed on any
surgical and medical appointments (Tulandi, 2013). They will also be educated on how to take

care of the patient in a way that helps in improving the quality of her life (David R. Gambling,
2013). In order to manage the pain, the patient can be put on the most appropriate analgesia
depending on the level of pain. From the given case, Janet did not report any pain from the
hospital hence did not necessarily need any pain relieving drugs. Instead, she only needed advice
and education on how to manage and care for her wound, any symptoms, and signs that she may
need to report to the hospital. An assessment should as well be conducted by a multidisciplinary
team consisting of occupational therapists, social workers, and continence nurses.
Occupational therapists team: This is a team of experts that would assist the patient with
movement. Janet having undergone surgical operation may develop problems and challenges
with moving from one place to another (Page, 2016). Occupational therapists would assist Jane
with improving her ability with doing tasks that would be associated with her daily life. Such
assistance will help the patient improve her skills and movement when doing such activities as
cooking, dressing, and bathing.
Social workers team: Diseases and disease conditions usually come with challenges that
may not only affect the patient but also the family (Miller, 2009). Social workers are known for
conducting the psychological functioning of the patients and then establish important
interventions that would help the patient adjust to the challenges and conditions that she could be
facing.
Conclusion
The complicated nature of medicine makes the treatment of the diseases of patients as just one of
the ways of caring for patients. At times it may require a team of professionals who are working

in collaboration in order to fully address the needs of a patient. Such needs include emotional
issues, pain management, rehabilitation as well as treatment. The field of medicine encompasses
adverse healthcare specialists and professionals with each professional having a different and
distinguished role to play. An understanding of the role of each of the medical practitioners is
important in ensuring proper coordination and appropriate service delivery to patients.

References
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